Westminster Hall Sitting of 16 October 2001

Preamble
[SYLVIA HEAL in the Chair]

Carers
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr.Pearson.]
9.30 am
John Robertson: I am delighted to have secured this debate to discuss an issue that affects not only many of my constituents but people across the country. I am confident that few Members will not have been approached by carers or carers' organisations in their constituencies highlighting the problems that they face.
I should like to acknowledge the care workers and care staff working in the UK, and the voluntary organisations that provide a valuable service to the national health service. This morning, however, I should like to focus on carers who look after a relative, friend or partner who, because of age, illness or a physical or learning disability, needs support and cannot manage without help—in other words, people who provide care through sheer necessity and not through a contract of employment.
The latest figures show that there are nearly 5.7 million carers in the UK, which is approximately one in seven of the adult population. The 1999 general household survey revealed that that number is increasing. For example, in 1999 there were 620,000 adult carers in Scotland compared with 500,000 only four years previously. The survey also showed that the number of carers providing support for more than 20 hours a week has increased by 13 per cent. since 1990. There are approximately 185,000 adults in Scotland at the heavy end of caring.
It must be recognised that providing care ranges from occasional help such as helping with shopping to providing continuous care. It is estimated that approximately 60 per cent. of carers who look after someone in their home provide personal care such as bathing, washing, dressing and toileting. A similar percentage of carers provide physical help such as getting in and out of bed, walking and getting up and down stairs. Approximately 27 per cent. of carers take responsibility for administering medicines, 60 per cent. look after someone with a physical disability, 7 per cent. look after someone with a mental disability and 15 per cent. provide care for someone who is both mentally and physically disabled.
The invaluable contribution made by carers should be properly recognised and supported. They contribute a great deal to society and save the NHS billions of pounds each year, yet they make untold sacrifices and often feel unsupported and isolated. The tasks involved can lead to physical and mental exhaustion and stress, which can affect the health of the carer and have a knock-on effect on the person being cared for.
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Figures show that the peak age for becoming a carer is between 45 and 64. Carers in that age group can feel socially excluded as many give up paid employment and a career to care for someone, and that can lead to financial hardship. As one 56-year-old carer said:
"I sacrificed my career to care for my parents. I deserve some recognition for what is now my employment."
Another carer said:
"I love my daughter dearly, but I have paid the price of caring. Now I would like to have a life too and follow some of my own dreams."
Young carers also experience stress and isolation as their schooling is often affected. Many of them are unable to enjoy the social activities that their peers take for granted. Worst of all, many carers feel demoralised by the lack of status that their role brings.
The general household survey also uncovered some disturbing facts about the additional help provided, or at least available, for carers. Some 53 per cent. of carers who live in the same household as those they care for said that they were the sole carer. Some 75 per cent. of those receiving care from someone who lives in the same household had no regular visits from professionals such as doctors, district nurses or social workers. The proportion of households that receive visits from health professionals is declining and that increases pressure on the carer.
The Government have already made bold moves to address those difficulties. They are increasing the recognition that carers receive, and easing the burden on their lives. The Employment Relations Act 1999 ensured that, for the first time, those who combined caring with employment would have the right to unpaid time off to deal with difficult caring situations, such as arranging residential care. The 1999 Act encompassed a range of domestic situations, including those involving unmarried partners, and carers who have responsibility for people living outside the family home.
In October 2000 my right hon. Friend the Secretary of State for Work and Pensions announced an extra £191 million aid package for carers; 300,000 of them could benefit from that in the next three years. Those measures led to the Government's consultation on the invalid care allowance, which was widely welcomed. The consultation period ended yesterday, and I look forward to hearing the recommendations that follow it.
The Government's proposal to allow carers who are over 65 years old to claim invalid care allowance for the first time is particularly welcome. ICA not only provides financial help, but confers recognition on the role that carers play. Benefit provisions for carers aim to maintain the income of those who give up the opportunity of full-time work to provide someone with regular and substantial care. It follows that those who have reached pensionable age do not sacrifice the opportunity of full-time employment, but as Age Concern rightly pointed out:
"many older carers are angry that they receive no financial support in recognition of the important role they play."
Extending ICA would help to secure equal treatment for all carers, and ensure that conditions of entitlement were uniform. I hope that the widely welcomed proposals to extend ICA to those over 65 years old will be introduced as soon as possible. There are strong arguments to suggest that the ICA should not remain an

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income replacement benefit, but should be extended to cover the additional costs that carers incur through their duties. There is a strong case for waiving the overlapping benefits rule.
Benefits for those who need care are often reduced or taken away altogether. A disabled person who lives alone but needs help from someone outside the caring profession is entitled to the severe disability premium, but once the carer is in receipt of ICA, the premium is scrapped. The person who is cared for is often unaware of that rule, and ultimately loses control of how his or her care is administered.
The premium allows the disabled person a degree of flexibility, but that independence is eroded once the premium is withdrawn. Carer UK and many carers have told me that that is a continuing problem. The severely disabled often face the dilemma of deciding which benefit they should claim. I hope that the Government will look into the matter.
The consultation proposes to allow the carer to receive ICA for eight weeks after the death of the person receiving care. That will make a huge difference to the carer, and will help them not only to cope with the loss of a friend or relative, but to adapt to a new domestic and financial situation. I commend the Government's recommendation and hope that it is implemented soon.
I welcome the proposal to change the name of the invalid care allowance to carers allowance. That will direct the focus away from those cared for and toward the carer, thus increasing awareness, recognition and the status of the role.
Some organisations have called for an increase in ICA. The Scottish Carers Alliance, among others, has called for ICA to be set at the level of the basic state pension. The Government recently indicated that the estimated cost of increasing ICA to that level would be £650 million in 2001–02. However, to be entitled to ICA, someone would have to be caring for more than 35 hours a week. Some carers work less than that, but others considerably more. For the sake of argument, let us assume that the 5.7 million carers in the United Kingdom average a 35-hour week. The minimum wage is now £4.10 an hour. If carers were paid an hourly rate for their work, it would cost the country a staggering £42.5 billion per year. The most recent official figure is £34 billion but that dates from 1993. The introduction of the minimum wage legislation alone does not account for the increase—we must keep in mind the increase in the number of carers during that time.
As things stand, most carers earn approximately £1 an hour. Considering that ICA is intended as replacement income for those who give up or are unable to take up full-time work, the current rate is far from adequate. Carers' organisations commended the Government for raising the earnings limit from £50 to £72, which will then rise in line with the lower earnings limit. That figure has not changed since April 1993, and the new level will make some difference to those who need to combine care with employment.
Some carers are hidden carers. They may not even know that they are carers and, because they are not known to relevant authorities, they may not be aware of the help to which they are entitled. In Anniesland, the
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Princess Royal Trust has pioneered a number of methodologies in partnership with local GPs and pharmacists in order to identify hidden carers. For example, GPs have written to their patients asking them whether they care for someone; pharmacists have been placing surveys in all prescription bags and health centres have been conducting surveys. In order to publicise the benefits and the help available to carers, it is important that those hidden carers are identified. The holistic approach taken in Anniesland has been very successful, and I would welcome a move by the Department to pilot such schemes nationwide. Although the Scottish Parliament has responsibility for many matters relating to health provision, in this area in particular, examples of good practice can be monitored and adopted for the benefit of the whole country.
The Carers and Disabled Children Act 2000 gave carers the right to an assessment by their local authority to determine whether they were able to provide the required level of care. Those assessments can make an enormous difference to both carers and those in need of care. However, many carers complain that it is often extremely difficult to get that assessment, and carers' organisations have told me that the social services, health authorities and other relevant organisations are often unaware of their obligations. I urge the Government to ensure that those professionals are aware of the need for assessments and are equipped to carry them out.
Carers have brought to my attention the poor standard of information and support that is often all that is available when someone in need of care is discharged from hospital. In many cases, someone leaving hospital will require care for the first time and carers often find that they are left without instructions or information on where to turn for help. GPs also need to play their part in identifying and supporting carers, and that requires Government support. Surveys conducted among GPs found that many perceived that they would not be able to meet the carers' needs. However, carers often have relatively modest needs such as needing information or being directed towards sources of help.
Research also reveals that up to 50 per cent. of carers have suffered a physical injury while caring, such as a strained back. A similar percentage of carers said that they had been treated for stress-related problems since they began caring.
Many GPs recognise that they can prevent the health of carers from deteriorating by supporting them. That, in turn, reduces the strain on primary care resources. The NHS plan puts forward prevention as one of the five key challenges that face the NHS, and ensuring that carers receive support will be crucial if the NHS is to meet that challenge
At the weekend, my mother's kitchen caught fire. She is almost 81, and I suddenly became aware that I was now her carer. The house was gutted and my mother was taken to hospital. She was, I am glad to say, all right. I was not at home at the time, but my wife took the call and we took mother to my house. My mother has great difficulty in walking. The toilets in my house are upstairs, as are the bedrooms, and the kitchen and living area are downstairs. My mother could not climb the

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stairs. She is an old lady who needs to go to the toilet regularly, and I had to carry her upstairs four times so that she could go to the toilet and then back downstairs to watch the television where she was comfortable.
Although I have a slight knowledge of what to do, it took me eight hours to get help from the local council's social work and housing departments. Can Members imagine what it would be like for someone who had no such knowledge? Clear and concise guidance is needed, including emergency and advice numbers. I hope that the Government will consider looking into ways in which carers' rights and the responsibility of local bodies can be publicised. Carers are often unaware that they can get additional assistance such as respite care, adaptations to the home, equipment for the disabled and meals on wheels. The 1999 general household survey found that only 22 per cent. of carers reported that the person for whom they cared received home help. Only 8 per cent. of those who are cared for received meals on wheels. Most shocking of all, perhaps, was the fact that almost 50 per cent. of carers reported that they had not taken a break of at least two days since they started caring.
I have raised a number of issues relating to the problems that carers face and I would like the Minister to answer some questions. What can be done about the unequal and confusing benefit system? What more can her Department do to ensure that carers are properly identified and supported? What additional help will be given to young carers? Will the Department look at ways of advertising the importance of caring, so that carers are more aware of the help to which they are entitled and so that key professionals are also aware of the problems that carers face?
9.48 am
Mr. Michael Weir: The hon. Member for Glasgow, Anniesland (John Robertson) has raised an important issue that affects many people throughout the country. Obviously, my particular interest is Scotland where, as the hon. Gentleman said, there are a great many carers. The hon. Gentleman rightly concentrated on the difficulties of the benefit system. For many carers, however, much wider issues affect their daily lives.
The hon. Gentleman mentioned holistic systems in Anniesland, but many other areas require joined-up government to consider the impact on carers and the persons for whom they care. I have some personal experience of that, particularly in regard to the care of children. Many carers of disabled children have great difficulty not only with benefits—including the invalid care allowance—but with the disability living allowance through which money is claimed for children. Negotiating that system and claiming the two allowances can be a nightmare. Many people are rejected on their first attempt and are forced to appeal, and thus the systems drags on. If a person is already caring for a disabled child and dealing with the associated day-to-day difficulties, it can be frustrating and depressing going through the benefits system.
Another problem is education. Hon. Members will be aware of the difficulties that those caring for disabled children face when they try to get them a proper education. Under the education legislation, local authorities can be forced to maintain a record of needs
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for such children. That provides the opportunity for someone to insist on provision for a child's needs, but that, too, can be difficult. Although some local authorities are good at operating the system, others are not, and achieving a record of needs can prove to be a real battle. One reason for that is that a record of needs can be a powerful tool for the parents of a disabled child in arguing that the particular educational needs of the child should be met. Local authorities face the problem of being under tremendous financial pressures. Education for disabled children is suffering, along with other education services, because of a lack of resources.
The Government need to look beyond benefits and examine the whole structure that is designed to help carers and their charges; that includes education and the health service. Although there is often integration between the health service and the social work department of a local authority, those services are overstretched and it is difficult to obtain the necessary level of care. Such matters must be examined.
Some of the proposals mentioned by the hon. Member for Glasgow, Anniesland are welcome. If the Government were prepared to extend the invalid care allowance to those over 65, that would be welcome and would find support throughout this Chamber. It is wrong that people over 65 cannot currently access that benefit. It was also mentioned that the benefit could continue to be payable eight weeks after the death of the person cared for; that would also be welcome. However, a longer-term solution must be considered. Many people give up their careers in their forties to look after relatives for many years, and it is extremely difficult for them to restart their careers later in life. After caring for a disabled person or elderly relative for many years, some people find it impossible to return to the job market. Serious work is required to find the best way of helping those people and to ensure that they are not penalised for their choice—one taken out of love and a sense of duty—to look after a disabled relative. It is important that the Government examine how to adjust for that.
The serious problem of overlapping benefits was mentioned. One of my constituents gave up work to look after her elderly mother. She was advised to apply for the carer's premium invalid care allowance, which she did. She was given the allowance but her mother's benefit was reduced by an equivalent amount. At the end of the day, she was no better off. In fact she was placed in great financial difficulty. The woman had given up her job to look after her mother, who would otherwise have had to be looked after at our expense as taxpayers, and she has been severely financially penalised by the way in which the benefits system works.
I was interested to hear the idea of a holistic approach that would consider all benefits together. The system requires simplification to avoid the situation where claims made for different benefits effectively cancel each other out. There should be a one-door approach so that the carer and the person being cared for can approach the Benefits Agency together and work out the best package for their needs. That would be better than having two applications going down different routes, both of which could take a long time to get through and eventually be pointless because they cancelled each other out. Will the Minister comment on that, and, when considering the report, look in detail at how the

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benefits system can be streamlined to aid situations in which both the carer and the person cared for are on benefits? A holistic approach must go beyond benefits. All Government Departments must be involved in examining how we can help carers, for example through education. In Scotland, that must involve the Scottish Parliament and its agencies.
Carers come from all age groups. We must examine how to support young carers who are looking after parents whose schooling is severely disrupted, and how to put respite care in place to prevent that. Those children's opportunities for the future can be severely damaged because they have taken on the duty of looking after a disabled parent. Job opportunities for those who have been caring for some years also need investigation. Will the Minister examine such points, and comment on them in her reply to the debate?
9.56 am
Dr. Evan Harris: I am delighted to contribute to the debate. We have some time left, as there have been surprisingly few contributions from Back Benchers. However, those that we have heard make up in quality what we have missed in quantity.
I pay tribute to the hon. Member for Glasgow, Anniesland (John Robertson) not only for introducing the debate at such a timely moment—at the end of the consultation on changes to invalid care allowance—but for having spoken in such a clear and structured way. He has raised many issues, refusing to look at care narrowly. I am pleased to see the Minister from the Department of Health here although some issues that have been raised relate to areas well outside her Department. We recognise that she may have difficulty in giving very detailed responses to questions relating to education, or to the work of the Department for Work and Pensions. The hon. Member for Glasgow, Anniesland let several hon. Members know which areas he intended to cover and I am sure that that will aid the debate.
I hope that the Minister will be able to answer some of my questions or at least recognise that I have asked them. The consultation on invalid care allowance has been widely welcomed. The Liberal Democrat party proposed something similar. Although we are sure that the Government came to a decision separately and deliberatively, we are always pleased at such coincidence of intention about an important change.
The importance of all the proposed changes should not be understated. Sudden bereavement can have a disabling effect on carers. It is unreasonable to expect them to go straight from the caring place to the workplace—from the home to the job centre—immediately after bereavement. That problem will be solved if the Government implement the proposal to allow ICA to be paid for a further eight weeks, as the hon. Member for Glasgow, Anniesland said.
Uprating in line with the lower earnings limit is also welcome. I hope that that will be pegged for the future so that it will be seen to rise as the lower earnings limit rises. There is nothing more difficult in a Member of Parliament's postbag than the complex benefit cases
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that we receive, especially in relation to the so-called overlapping benefits—a phrase that hides some of the complexities and three-letter abbreviations. When I get a letter asking whether the SDP is valid, I think back to my own political history as well as wondering what on earth is going on.
A huge amount of support is available to carers, if they only knew, through the Citizens Advice Bureau, through carers' associations, in my area set up by the Princess Royal Trust, and through tertiary referral from the citizens advice bureau to welfare rights organizations, which do tremendous work. I pay tribute to Peter Turville and his colleagues at Oxfordshire Welfare Rights, whom I have never known to lose an appeal. It is important to recognise the work that is being done.
It is difficult for carers to know that such help and advice exists. Many are too busy caring to realise that it is out there, or too stressed to access it. The Government should consider some form of wider advertising campaign so that the take-up of help and benefits is greater. The Exchequer may see some merit in unclaimed benefits, but it is the policy of all Ministries to try to ensure maximum take-up. It is such a complex area that there should be a way of ensuring, through outreach, that information is more accessible. For example, in my constituency a carers' centre has gone into GP surgeries to offer a carers' clinic, because GPs are often likely to pick up problems that carers are suffering as a result of work load or stress. Although that may not be the first thing that they mention to the doctor, it may be the underlying cause of their complaint. We should take a more holistic approach whereby GPs and other health care professionals think of referring a carer for social services assessment or reassessment and for help and advice with accessing benefits for themselves or for the person for whom they are caring.
As the hon. Members for Angus (Mr. Weir) and for Glasgow, Anniesland said, the earning potential of people with caring responsibilities is significantly impaired by their caring duties. Consequently, they are less likely to be able to contribute to a work-based pension scheme or to make provision through a private pension. Moreover, most of the burden of caring falls upon women, who traditionally have never had the opportunities in the workplace to improve their pension position over and above the state pension. Support for the basic state pension is—the Minister may not find this a fashionable word—a feminist act. We must deal with that indirect discrimination by making extra pension provision for women who may be caring for disabled children because of their traditional caring role or, owing to their greater longevity, are looking after a partner or parent who is disabled or otherwise in need of care. The debate about the appropriate level of the basic state pension and the minimum income guarantee—which requires means testing—has taken too little account of their disproportionate impact on elderly carers.
While I am on the subject of support for carers who are discriminated against, the Minister may be aware of the question of pension sharing for partners who are not married. I have participated in many campaigns concerning people—of the opposite sex or the same sex—who live together but are not married, one of

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whom has taken on a caring role and has been unable to benefit from bereavement benefits from the pension scheme where the person cared for has a pension scheme in the state sector. Traditionally, the private sector has made much greater allowance for that, and it is sad that the state sector has failed in that regard.
The statutory public sector pension scheme has failed to keep pace with the modern era. A carer who has worked in the health service for his or her entire working life as a nurse—a relatively low-paid job—and who is caring for another nurse, will find that the NHS superannuation scheme does not recognise their partnership and position of care I hope that the Minister will provide for less well-paid workers the same benefits that her colleagues and other hon. Members voted for themselves after considering a resolution for another public sector pension scheme—the MPs' pension scheme.
The hon. Member for Glasgow, Anniesland also mentioned the importance of assessment for carers. There is a statutory right to assessment, but many carers say, "Yes, we have a statutory right to an assessment of our needs, but do we have a similar right to access the care for those needs that the assessment states is appropriate?" To judge by letters that I have received, the squeeze on social services funding that occurred during the last Parliament is a major problem not only in my constituency but in the whole of Oxfordshire and throughout the country. Funding for social services, which is so important in providing help and respite care for carers, was cut in real terms in the first two years of the last Parliament. Overall, funding barely rose during the last Parliament, despite an ageing population and the additional duties that were imposed on social services departments.
Yet again, Oxfordshire and many other local authorities face a squeeze on spending. It is the non-statutory duties—the discretionary provision of services—that are affected. Often, that impacts on support for carers. As we know, there is pressure on beds in the intermediate care sector. When there is such pressure, respite care, for which such beds are often used, is squeezed. Is there a strategy, plan or target—on this rare occasion, I will accept a target from the Minister—in respect of the availability of respite care beds in the NHS or, as a second preference, in social services? In Oxfordshire and many other places, the reduction in community hospital beds serving that function has proved damaging to respite care.
Of course, the Government recognise that without proper provision of respite care, carers are often unable to continue their work. Such a breakdown of care roles can lead to an acute hospital admission. The hon. Member for Glasgow, Anniesland rightly pointed out the amount of what is in effect unpaid work that the state gets out of carers. Official estimates of the value of such work range from £34 billion in 1993 to £42 billion now. Such figures show the possible effect on social services expenditure of failing to provide adequately for continuation of the caring role.
In both social services and in the health service, the pressure for early intervention in care should start with the carer. It is the carer who knows best how well a person is coping. In terms of greater care needs, carers sometimes know better than even health care professionals the likely prognosis for those in care. The
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early provision of extra support and information for carers can increase the independence of those cared for, which, as we recognise, is one of the Government's aims.
The story that the hon. Member for Glasgow, Anniesland tells about his mother is salutary. It shows that even someone who knows their way around the system can find it difficult to combine the burden of caring with accessing all available care in good time. It is important that we recognise the need to empower carers. That could be done by making available a recognised advocacy service to provide carers with advice. Does the Minister have plans to use NHS Direct as a way of ensuring that carers have access to, or at least the ability to be referred to, the appropriate sources? A one-stop shop is a nice idea, although we recognise that NHS Direct may have to refer, or continue to refer, to more appropriate sources.
The hon. Member for Angus raised the issue of carers with responsibility for children having to fight for a statement of special educational needs, a continuation of that statement, or the meeting of the needs identified in that statement. I remember having many long debates about this matter with the hon. Member for Redditch (Jacqui Smith), now the Minister of State, Department of Health, and I know that she continues her interest in that subject in her current duties. Local education authorities are variable in their ability to communicate as well as provide, and I recognise the tremendous work done by the National Autistic Society and the Independent Panel for Special Education Advice in providing advice to carers and parents who have written to me.
It is appropriate that this debate is followed by a debate on long-term care. I shall not stray into that area, but it would be appropriate to mention issues such as continued independence and people living at home who require long-term care. Those issues relate to the needs of carers and the appropriate treatment of that sensitive time when care at home breaks down, often because the carer is ill. The availability of prompt, appropriate and accessible respite for the carer, if he or she becomes ill, and for the cared-for person, needs to be developed to provide a safety net to enable people with caring responsibilities to continue in that role.
In debates on health service funding, not only in the House but in the media, I hope that more attention will be given to the important role played by social services and carers. If budgets for social services and carers are not increased in line with the needs of an ageing population, which are often recognised in the health service, but not in relation to those areas, there will be a greater gap between what is needed and what is available for the carers—the heroes and heroines of today's society.
10.12 am
Mr John Lyons: I support the points made by my hon. Friend the Member for Glasgow, Anniesland (John Robertson), and by the hon. Members for Angus (Mr. Weir) and for Oxford, West and Abingdon (Dr. Harris).
The debate has included some wonderful examples of care throughout the UK. No matter which survey or assessment we look at, one consistent point emerges: the

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number of people who are caring and the extent of the care that they provide in the communities that they serve are underestimated. I am also struck by the clear disparity between constituencies: no two constituencies seem to work in the same way. No matter where one looks, there are different approaches: in some places the approach is very good, but elsewhere a lot of attention and support is needed.
As was discussed earlier, carers need to have access to and clear and concise information about the available services. All too often, the attitude seems to be that if carers do not make an approach, they will never find out what is available. We need to reverse that. I welcome the efforts of primary health care trusts, GPs and others to identify carers in communities. That objective has been lost somewhere along the line. We must ensure that GPs and other primary care and social services have that responsibility.
Earlier, the point was made that we have a record of children's educational needs, and there is no reason why we should not have an assessment of the needs of carers and the persons for whom they care. Again, that could be done throughout the United Kingdom so as to ensure that we introduce regulations and support for every carer, on which they could rely, knowing that they have support for what they do and that that support is consistent throughout the country.
Clearly, if we are serious about joined-up health care, whether it is primary care or social care, we must ensure that we do not have only a theoretical approach. It must be a living reality for people out there. Joined-up government is not simply a political matter; people should be able to access services without hitting major problems. That is the core of the argument and the debate. People need positive support to try to make life that bit easier. Accessing services, benefits and support should not be an obstacle course; they should be provided in a seamless way, so that carers are confident that they receive proper support and that the person for whom they care has proper support, and so that nothing that is properly due is denied to the carer and the person being cared for. It is important that we continue to emphasise that.
We must re-emphasis and accept that caring occurs across the age range—from the youngest person to the oldest. I recently received a letter from a woman of 70 asking for support, and I immediately asked myself why the carer was not writing. The person of 70 was the carer; she was caring for her mum of 93. She thought nothing of that and had done it without support for a long time, but now—understandably at the age of 70—felt that she was reaching a point where she was letting her mother down and could no longer continue to do what she had done for years. We must recognise that that is not an isolated example, but that it happens throughout the country, from the very youngest to the very oldest—that is the age range of caring. We cannot allow people to talk about carers being of only one age because it occurs across all age ranges.
We must be serious and, if we value caring, we must put our money where our mouth is and say that caring is not a cost, but an investment. If we treat it as such, we will treat it in the proper and right way.
10.18 am
Annabelle Ewing: I thank the hon. Member for Glasgow, Anniesland (John Robertson) for securing the debate. Many important matters have been debated and there is a reasonable consensus among those hon. Members who have spoken, which will please the Minister. We all agree that carers play an excellent and key role in our society and none of us underestimates the importance of carers to us all. However, having talked to carers in my constituency and elsewhere in Scotland, I know that they feel badly let down by the policies of this Government and the previous Government. We must ensure that carers are treated properly and given the respect that they deserve, to which the hon. Gentleman referred. However, I must question whether the limited nature of the proposals that he mentioned will go far enough toward securing those objectives.
I will keep my comments brief because my hon. Friend the Member for Angus (Mr. Weir) has outlined several specific questions that he would like the Minister to address. However a few points that have arisen merit particular mention. The first concerns the news that carers are to receive a payment after the death of their dependants. That is a welcome development, but why has a period of eight weeks been proposed? What is so special about an eight-week period? Why has a longer period not been proposed, and if that is not possible, will the Minister consider whether an element of discretion could be built in with regard to applications for such payments?
As hon. Members have mentioned, and as my mailbag reveals, a key problem with the benefits system, aside from its complexity, is that discretion is seldom built in to allow an appeal tribunal to examine the particular circumstances of a case and to make a discretionary decision. That is unusual, because an element of discretion is usually allowed, and that is the mark of a fair system. Will the Minister consider, with respect to the eight-week cut-off point, whether an element of discretion could be built in?
The need for more information has been mentioned, and that is of key importance. Many carers do not know what they are entitled to, and that is shocking. I ask the Minister to examine that problem, as it could easily be addressed.
Respite breaks for carers are not specifically covered by the proposals under discussion but, as the subject is being debated, I ask the Minister to outline the Government's intentions in that regard. When one talks to carers they say that one of the major problems that they face is that they do not have sufficient opportunity to take breaks from their arduous duties.
The hon. Member for Glasgow, Anniesland referred to the £191 million package to help carers over the coming three years, but that figure should be put into perspective; £750 million was spent on the millennium dome, which was a colossal waste of money.
Finally, I wish to express my agreement with the comments made by the hon. Gentleman and other hon. Members about the difficulties involved in the overlapping benefits system. It is cynical to offer with one hand what one takes away with the other. That matter should be addressed, as it would help carers, as well as everyone else who has to go through the tortuously complex benefits process.

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I look forward to hearing the Minister's response to my questions.
10.22 am
Tim Loughton: I congratulate the hon. Member for Glasgow, Anniesland (John Robertson) on securing the debate. It addresses a subject that is becoming increasingly important and the hon. Gentleman has personal experience of the daily pitfalls and concerns that affect millions of ordinary people.
It is a pity that more hon. Members are not present. I feel like the token Englishman, as I am the only contributor who does not represent a constituency north of the border. However, I am sure that that is an accident, as the concerns that have been raised apply to the entire United Kingdom—[Interruption.] I acknowledge that the hon. Member for Oxford, West and Abingdon (Dr. Harris) hails from west of the English border.
It is also appropriate that, as has been mentioned, yesterday marked the end of the consultation period on the proposed changes to the carers allowance, as it is now likely to be called. However, today's debate concerns the often neglected army of millions of carers in communities throughout the country, without whom the national health service and social services would be unable to function. As the hon. Member for Glasgow, Anniesland said, there are approximately 5.7 million carers and many hidden carers—at least one in seven of the population. A carer is not only someone in receipt of benefits in recognition of that role. Many care for people on a day-to-day basis, and not only for those with high profile, long-term and chronic diseases such as Alzheimer's disease or Parkinson's disease. Many care for immobile spouses, people with learning difficulties or disabled parents, as the hon. Member for Angus (Mr. Weir) mentioned earlier.
The hon. Member for Strathkelvin and Bearsden (Mr. Lyons) struck a chord when he spoke about older carers. Although it may have been rare for him to have been approached by an older carer in her seventies, as my constituency includes Worthing, which has the largest elderly population in the country, I regularly meet people in their seventies who are caring for parents in their nineties—many people in Worthing are in their nineties—and they cannot continue to do so. Some people have cared for elderly parents for 10, 20, 30, or 40 years and they are physically exhausted. That is commonplace in my part of the country.
It is not only the elderly who need care. Many cases involve children and young adults. For carers involved in such cases, the responsibility may continue for much longer than for those caring for elderly parents.
People are living longer, so the problem is getting worse. If we examine the complexion of carers, we find that most are women, in an age in which increasing numbers of women are going out to work. That means that the pool of carers is decreasing. Also, as we have heard, the impact on potential careers and earnings for such carers is severe, which has repercussions such as the lack of savings and pension plans to contribute to a carer's future prospects for long-term care.
Today's debate is an opportunity to acknowledge and praise the work of the unsung army of carers, to pay tribute to organisations such as the Carers National
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Association that provides essential support, and to raise the profile of everyday issues that affect the millions of carers who we are in danger of being taken for granted. It is in all of our interests to make the job of carers easier. Rather than placing more regulations and onerous requirements in their way, we should be asking them, "How can we make your job easier and provide you with the tools to do it?" Without carers enormous costs would fall on the state.
The hon. Member for Glasgow, Anniesland mentioned some figures that surely underestimate the problem. Glaring statistics such as carers earning the equivalent of £1 an hour are appalling. He also mentioned, rightly, that the carers allowance is not only a financial help, but a recognition of the status of carers. I am aware of the debate on the problem of overlapping benefit. People who receive a state pension no longer receive carers allowance. Someone who retires from a job can take it easy, but there is no retirement for someone caring for an elderly relative, even at the age of 85, probably until that relative dies. There is no retirement for many carers. They do not get the carers allowance after the age of 65 if they are in receipt of the state pension.
I welcome many of the changes that the Government announced to the invalid care allowance and some of the proposals currently subject to consultation. We welcomed much of the Carers and Disabled Children Act 2000, which came into effect just over six months ago, earlier this year. It is right that under the terms of that Act services are provided directly to carers to help them in their caring roles and to help them maintain their own health and well-being. We recognise the terms of that Act, which highlighted families as the natural and appropriate places for caring for children, which is absolutely right.
At the same time, as many hon. Members have already said, we need to recognise the extra duties being placed on already hard-pressed social services departments, in many cases without the full necessary funding associated with those additional requirements. For example, under the Carers and Disabled Children Act 2000, carers grant is to be paid to local authorities at 100 per cent. of the £70 million being given for carers grants for 2001–02, which will ostensibly require no contribution from local authorities. Will the Minister give an undertaking that that will be so next year, so that money is not drained from hard-pressed social services departments through the back door, having placed the extra requirements on them?
An issue of local autonomy is involved, which must be balanced with ensuring that the money goes to the right places. Carers grant guidance states:
"Local councils are expected to spend their allocations broadly in line with the following Government targets except where there is a strong case to be made for doing otherwise."
Much criticism has been made, in many cases rightly, of the prescriptive, ring-fenced nature of so-called additional funding for local authorities, especially social service departments, which has impeded the flexibility of local social services departments to respond to local circumstances. Beside that, however, we must balance the fact that in some cases funds are being allocated to improve provision for carers, especially in respect of respite care, but are sometimes arrested at source because local authorities view the money as a way of offsetting the costs of care that they already provide.

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It is essential not to tip the balance too far either way. Social services departments are stretched on all fronts, as all hon. Members will agree from their experience with their constituents, whether in child care, care for the elderly, residential care or care in the community. This year there is already a budgeted overspend above standard spending assessment among social services departments of some £916 million, or 10.2 per cent. Authorities must spend more than that merely to fulfil the minimum requirements placed on them. In my area of West Sussex, which has the largest number of elderly people in the country, the social services department needs an extra £12 million merely to stand still and fulfil the extra requirements that the Government have placed on it. We received £7 million, giving a £5 million shortfall.
The problem is getting worse simply because of the demographics involved. By 2007, the number of pensioners in this country will for the first time outnumber the number of people under 16. Over the next 20 years, the number of over-85-year-olds, the most expensive to provide care for, will double to more than 2.2 million. The chances of an over-65-year-old man requiring residential care is 9 per cent., and for women the figure is 13 per cent. Those figures do not take account of nursing care. That means extra requirements on social services, care in the community and carers looking after people who do not enter residential and nursing homes.
An estimated 700,000 people in the United Kingdom have dementia—one in 20 of the population aged over 65, and one in five of the population aged over 80. As hon. Members have said on several occasions, there is a big disparity in the level and standard of guidance and care provided, a point made by the hon. Member for Strathkelvin and Bearsden—
Mr. George Stevenson (in the Chair): Order. We are in danger of straying to the next debate on care of the long-term elderly. I understand the connection, but perhaps the hon. Gentleman would bear that in mind.
Mr. Loughton: I am grateful, Mr. Stevenson. There is a strong connection, but I am concentrating on people with problems such as dementia and Alzheimer's disease who are cared for at home and are not in long-term residential care. The Alzheimer's Disease Society has said that 40 per cent. of those who care for people suffering from Alzheimer's disease have less than one hour a day to themselves, and that places enormous pressure on them.
The hon. Member for Strathkelvin and Bearsden referred to respite care, which is an important consideration. I held a public meeting in my constituency for representatives of disability groups, which included many carers, and a matter that arose time and again was the shortage of respite care facilities for hard-pressed carers. It is crucial that the Government recognise the extent of the problem—the simple voucher system that they have introduced is not sufficient. It is crucial that appropriate cover is available for respite care and that places are available in residential homes, but 100 care homes are closing every
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month. It is essential to recognise the necessity of providing respite care while carers are trained. Carers need training and they need cover to enable them to undertake that training.
Earlier this summer the Carers National Association carried out a survey of 2,000 carers. It highlighted a number of weaknesses in the system. Those weaknesses are worth repeating. Hospital discharges are increasingly likely to be poorly planned, timed and handled. That was highlighted in the survey entitled, "You can take him home now". In 1998, 25 per cent. of patients had to return to hospital within two months of discharge, but that figure has leapt to 43 per cent., which has led to enormous extra pressure on the shortage of acute beds, particularly when there is a bed-blocking problem. In my local hospital, 10 per cent. of beds are blocked by people for whom residential care cannot be found.
The survey also found a huge drop in the satisfaction level of carers since 1998; 72 per cent. of those surveyed said that they had had bad experiences and 43 per cent. said that they had been given too little help. Carers are picking up the pieces when hospitals fail. The number of carers who receive a care plan has fallen from 28 per cent. to 20 per cent. during the past three years. The number who are consulted before discharge has fallen from 71 per cent. to 64 per cent. and the number who say that their comments and concerns had been ignored has increased from 36 per cent. to 45 per cent. Many carers are feeling unloved, ignored and neglected and the Government must address the problem urgently.
I turn to the need for greater employer flexibility. Many companies are rightly latching on to the fact that it is important to recognise the pressures of caring for children or elderly parents if their employees are to remain healthy and to contribute fully as employees. At the moment, there is one pensioner aged over 65 for every 3.7 working people in this country. By 2020, that ratio will have decreased to 1:3.1 and, alarmingly, by 2040 there will be barely two people of working age for every person aged over 65. The elderly population is increasing rapidly and those who care for elderly patients are likely to be experienced senior employees in their late 40s and 50s whom companies can ill afford to lose.
I pay tribute to companies such as Centrica, which recognises the problem. Its employment policy provides free access to telephones for personal calls for people who must deal with day-to-day matters for their charges; it allows flexible hours and breaks for carers with additional paid leave to match the caring that they may have to undertake. Companies should be more innovative and creative in their thinking.
Carers should feature prominently in the cycle of treatment, post-treatment aftercare and long-term care in the community. They should feature in patient plans for those who require care. That would also benefit hospitals by reducing the avoidable re-admissions that occur all too often. Better information should be available from general practitioners to carers to take the pressure off them and reference has been made to carers clinics and that is an interesting idea. We need greater interaction between carers and social services to ensure the right number and level of expertise of home visits, the availability of the right equipment to those with

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disabilities and the maintenance of that equipment. The need for respite care and training should be recognised and local support groups should be available. The hon. Member for Glasgow, Anniesland suggested that advice numbers and hot lines might also be available.
Above all, carers must be valued by the Government and all of us and their essential work should be recognised by the Government and employers better than at present. I shall repeat my opening comment that they save the country, the NHS and social services an inordinate amount of money and it is incumbent on all of us to make their essential and thankless job as easy as possible.
10.41 am
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I congratulate my hon. Friend the Member for Glasgow, Anniesland (John Robertson) on securing what has turned out to be a very wide-ranging debate. The contributions from all hon. Members have given me the central message that the issue is not simply a matter for the Department of Health; the needs of carers and their families affect policy across the board. That message has been a benefit of the debate today. I shall try to deal with as many specific points as possible, but I shall also ensure that, where relevant, Ministers in other Departments are made aware of what has been said today to ensure that we provide a co-ordinated response to the many issues that have been raised.
My hon. friend the Member for Glasgow, Anniesland set out the extent of carers in this country. We have almost 6 million carers, including around 1.7 million who devote 20 hours a week to caring, and 855,000 who devote in excess of 50 hours a week to caring. That is an enormous contribution and we all echo the comments that have been made today and pay tribute to the amount of work, dedication, commitment and sheer energy that carers provide in looking after their friends, family and neighbours.
Most caring is undertaken by close relatives, but society is changing dramatically. In modern society, families are often separated, sometimes by vast distances. In times gone by, families lived close together or next door and could pop in and keep an eye on people. Today, families are more fragmented and it is more difficult for communities to provide the support structures that many of us have known in the past.
The age structure of the population is also changing dramatically. During the next 30 years, the number of people aged more than 65 will rise from 17 per cent. to 24 per cent. of the population. We hope that our policies will ensure—the evidence for that is becoming clear—that older people will be fitter and healthier and will enjoy many more years of active life, but we must recognise that there will be a much greater number of older people in the community.
Almost half of us have the chance of becoming carers and my hon. Friend the Member for Glasgow, Anniesland illustrated graphically the shock that many people suffer when they suddenly become carers and have to obtain access to the range of available information. Carers have a tremendous job in juggling their caring responsibilities with their work and families. Around 2.7 million people combine a caring role with
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work and, as the hon. Member for East Worthing and Shoreham (Tim Loughton) said, we must find ways of ensuring that employers and services support working carers so that they do not have to give up work when they take on a caring role. That is important economically, but it is also important in terms of social isolation and social exclusion, and the respect that carers need to be shown. Carers do not work simply to draw in income; many of them need to keep the connection with their work, through continued training and support, to ensure that their lives are not completely devastated by taking on caring responsibilities.
The Government have started from an important point, by asking carers what services they want to be provided. That must be reflected across a range of policies. We start by asking patients—the people for whom we provide services—and the public about their priorities, rather than assuming that we know best. Most carers said that they suffered health problems; many have financial difficulties and problems with stress and isolation within their communities. As hon. Members have said, we must ensure that we provide a joined-up response to what carers have told us, by utilising our various regeneration projects, giving primary care support—which is absolutely crucial in the community—and financial assistance to those in work and to those unable to work due to their responsibilities.
We must also help people make the transition from caring into employment, as that is a difficult time for people. The hon. Member for Perth (Annabelle Ewing) raised that issue, which is a key one for us. She also referred to the payment of the carers allowance for the eight-week period following the period of bereavement. That is linked to the period for which we pay the carers premium in relation to income support; clearly, there must be a cut-off point in the provision for that transition. The hon. Lady made an important point about the difficulties that people face when their circumstances change dramatically, but we are aligning the benefit system to reduce the number of anomalies in it. Hon. Members have referred to the difficulty in finding one's way around an incredibly complicated system. We recognise the points that all hon. Members have made about overlapping benefits—all of us would wish there to be more consistency in the benefits system.
I pay tribute to the carers centres that are springing up in many parts of the community, many of which are supported by the Princess Royal Trust. Those centres can act as one-stop shops, where carers and their families can find help with benefits and social activities. Hon. Members have not so far highlighted the wonderful things that many carers do when they get together; they provide a great deal of support for each other. They do not simply look for support from outside agencies; they get together in self-help groups, in social and family activities. I am personally aware of the tremendous range of facilities that carers centres can provide in our local communities.
We have also launched "Looking after someone", which is part of the Government website. More people are gaining access to the internet and to information online. The website contains a whole range of information for carers, about benefits, support services and facilities in their communities. Perhaps we should make an effort to publicise the breadth of information that is becoming available.

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We have taken a great deal of action for carers in the past few years, based on our strategy from February 1999, when we published "Caring about carers". That was a national strategy to ensure that people obtain information, support and financial help. When that strategy was being developed, the one thing that carers highlighted was the need to have some time out from their responsibilities; they need to find some respite and do something simply for themselves as a break from the pressures of the week. That is why we introduced the carers grant in February 1999, for which £70 million has been set aside this year. The hon. Member for East Worthing and Shoreham asked us to assure him that that would be available in future years. I can give him some good news: the £70 million for this year will increase to £85 million next year and to £100 million in 2003–04. That is ring-fenced funding, which should ensure that the services are provided. It is ring fenced because carers said, "We want that money to be available for breaks and respite care. It must be spent on those crucial services." This is an example of the Government responding to the views of carers who have told us their priorities. It will help local authorities to ensure that carers get the breaks that they want.
Exactly how local authorities spend the money is a matter for them, but we shall monitor their expenditure because we want to ensure that we obtain value for money and that carers obtain value for our investment. The balance between local discretion and national standards is a careful one for us to strike. When carers tell us what they want, we are determined to provide a system that channels money to them and their families to provide crucial breaks. We have already set up a system through the King's Fund that will evaluate that expenditure, so we shall be able to obtain evidence of what local authorities are doing.
It is important that we share good practice. Rather than continually reinventing the wheel, it may be that one local authority has a marvellous scheme from which others can learn; sharing ideas will be extremely important.
It is also important that we respond to carers' individual needs, such as when they want a break, the circumstances in which that can be arranged and what help is appropriate for the person for whom they care. One size does not necessarily fit all because people have different requirements in their families and personal circumstances. Involving carers in designing their breaks will therefore be important.
We have introduced the right for carers to have an assessment made of their needs. I am therefore delighted that there is consensus on the importance of caring services. Sometimes relatively small things can help carers to do their work better, such as practical help at home or the provision of taxi fares. Transport is an issue that has not been raised today, but it is crucial to the independence of carers and those for whom they care. It is important to try to help such schemes.
My hon. Friend the Member for Glasgow, Anniesland, he has pursued benefit issues to good effect for some time. The changes to invalid care allowance, which is to be renamed carers allowance to reflect properly the job that carers do and to give them the
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status, respect and recognition that is fundamental to our policies, mean that it will be extended to carers aged over 65. All Members who have participated in today's debate have welcomed that. The lower earnings limit will also be increased to £72 a week, which will greatly assist people who are able to work as well as to care. The allowance will also be extended to eight weeks after the death of the cared-for person. That package has been issued for consultation, which ended yesterday. It will be possible to introduce those changes by the new procedure of a regulatory reform order, which means that we can get it done faster than would previously have been the case. We shall do that as soon as we can.
In terms of financial support, from April next year the second state pension will boost the second tier pension of low earners, carers and some disabled people. There will also be a reduction in council tax for people with disabilities who live in band A properties and their carers. That package of financial measures will underpin the independence of carers and their families.
Several Members raised the issue of young carers. They are a hidden group who are not immediately visible in the community, which is something that the Government take seriously. Young carers are often faced by the prospect of many years of caring responsibilities. Ensuring that they get access to education and social opportunities so that they can, as far as possible, live the same lives as other youngsters in their communities is key. We must ensure that young people have access to the same facilities as anyone else. It is their right, and it is our duty to provide for it.
Our research shows that in years gone by the hidden group of young carers has not been as high a priority as it should have been. We have therefore introduced the quality protects programme to improve children's social services. We have also funded a project to help the Children's Society to take forward a young carers initiative. The society consults young carers directly about their views and needs and about exactly what should be put in place. It is fundamental to our approach that we will not tell young carers what they need. We want to talk to them about their lives and what they think is important. We want to develop a database and website to ensure that people have information, and a practical guide—a resource pack—for young people, so that they feel supported. They need to know that they are no longer the invisible carers, carrying a huge burden of emotional and physical care, and that people out there will provide accessible help when and where they need it.
We are making progress in helping disabled young people, through examining ways in which the quality protects programme can help a further 6,000 disabled children and their families by 2002.
The complexity of the benefits system has been mentioned, and the hon. Member for Oxford, West and Abingdon (Dr. Harris) raised the possibility of pension sharing for unmarried partners. That has been discussed in Parliament. His points about public sector superannuation schemes were valid and important. I will take up the matter in relation to benefits schemes, although on the many occasions when this has been discussed, issues about the structure of the pension schemes have been raised.

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I will dicuss the complexity of the benefits system and the impact of overlapping benefits with Ministers in the Department for Work and Pensions. I recognise that it can be difficult for carers to find their way through the system.
My hon. Friend the Member for Glasgow, Anniesland referred to the serious problem of identifying carers. Much work is being done with general practitioners in that respect I understand that an additional question in the census will enable us to identify carers in the community. When we collate the census information, we will be able to add further details to the effective database that we already have about where carers are located. We can then target the best help to them and their families. That is crucial.
Several hon. Members suggested a helpline or a one-stop shop for advertising services. NHS Direct is a gateway into health and social services, but we are also piloting Care Direct, which is specifically designed to target people who are caring, including those who are elderly, disabled or children. That will tell people about the range of services available for them locally. People often want to know what is available for them in their communities, rather than national information. Care Direct will provide a good access point into the range of caring and support services, including benefits, aids and adaptations, and the support available through housing and education. It will enable us to join up the various services that national and local government provide for carers and their families. We will be interested to see the results of the Care Direct pilots, and I can undertake to keep my hon. Friend the Member for Glasgow, Anniesland informed about those services.
Important issues have been raised in today's debate. As the hon. Member for Perth said, we have had a degree of consensus, and I am delighted by that. We all want to do much more to recognise the enormous contribution made by carers. My hon. Friend the Member for Glasgow, Anniesland quoted stunning figures showing the value in financial terms of carers contributions. In addition we must recognise the time, energy and commitment that carers give to their friends, family and neighbours. Many carers in our country look after their friends and family because it is what they have always done and what they want to do. The Government must recognise that our job is to put in place support mechanisms to enable them to do that, while retaining their independence, dignity and respect in the community. We are determined to do that, and I am sure that all hon. Members want us to recognise the tremendous contribution that carers make to our communities.

Elderly People (Long-Term Care)
11 am
Mr. David Heath: I am grateful for the opportunity to introduce this extremely important debate. It is about one of the most important matters that we can discuss, because in the long run it affects us all in one way or another. It is a truism to say that the way in which elderly people are treated is the measure of a civilised society, but I have great concerns about the level of provision and the way in which it is organised. Those concerns originated some years ago, when I was for a time actively engaged in discussions with care home owners and my social services department. They were given added immediacy a few months ago with the very sudden closure of a nursing home on the edge of my constituency, as a result of which the residents, who had lived there for a long time, were given just a week or so to find new places to live. None of us would wish that to happen to elderly and poorly people, who are some of the most vulnerable in our society.
I do not use the term "crisis" loosely—it is often overworked in politics—but I fear that we truly face a crisis in long-term care. A crisis is not merely developing but has already developed in many parts of the country, especially where there is a preponderance of elderly people. The Minister will be familiar with the national figures. About 50,000 long-term beds have been lost over the past five years, with an accelerating loss of 28,000 beds over the past two years. That has been accompanied by loss of placements and loss of front-line care staff—not only in care for the elderly but across the board within social services.
In my county of Somerset, we are not immune to that trend. Indeed, the west country has a significant population of elderly people. In the year to April, Somerset saw a 10 per cent. reduction in the number of available nursing home places. Again, there is an accelerating trend—a further 200 beds have already been lost this year since April and it is reasonable to expect that at least another 100 will be lost before the end of the year. That is bad enough in itself. However, there is a specific problem within that bald figure, in that we have particularly lost places for sufferers from the various dementias. That is a difficult group of people to cater for effectively, and once places have been lost it is much harder to find alternatives for them.
Along with the loss of nursing care places, we have lost a significant part of our home care service. In some parts of the county it is difficult to provide an adequate level of domiciliary care, not least because providers are finding it extremely difficult to recruit and retain suitable staff. I underline the word "suitable", because not everybody has the vocation or the ability to do such demanding work for very little pay. It is hard to ensure that sufficient numbers of staff are in the right places. As a result, it is not unusual for there to be a four to six-week wait for the delivery of larger-scale care packages. That is not something that we in Somerset wish to see.
The automatic corollary of the loss of nursing home and residential home places is the problem of bed-blocking. In the south-west, there has been a phenomenal increase—54.1 per cent. in two years—in the number of delayed discharges. That is worrying in

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anybody's book, and it has knock-on effects for our hospitals. It makes it difficult, for example, to transfer patients from accident and emergency units to ordinary surgical or medical wards. That affects staff morale, because they are unable to do the job that they would like to do in the way that they would like to do it. Delayed discharges also directly affect the patients themselves. They affect their well-being in the ordinary sense of the word, but a prolonged stay in hospital can also often lead to an increased risk of hospital-acquired infections. That is a worrying prospect, given that, as we must remember, we are dealing with elderly people.
I do not wish to gloss over or neglect a major national policy difference between my party and the party of government in the United Kingdom, but I do not wish to dwell on it either, as it has been sufficiently advertised elsewhere. Of course, the difference exists only between my party and the UK Government; we have no such difficulties with our partners in government in Scotland. Nevertheless, in England there is disagreement as to whether personal care should be paid for. We believe that, as the royal commission said, it should be paid for.
The differentiation that the Government have introduced into the process of delivering service is artificial and deeply damaging. Deciding whether care should be paid for on the basis of who provides it rather than according to the type of care provided seems an absurd way to proceed. That has a particular resonance in respect of dementia, which I have raised before on the Floor of the House. It is impossible to draw a line between services that comprise personal care and nursing care. It seems that the only definition that applies is whether a registered nurse provides the service, and that cannot be right.
I am also concerned about the position of disabled people. They need support, whether they are in their own homes or in residential homes.
Mr. David Drew: Another problem is the handling of information on individuals and homes. Is the hon. Gentleman familiar with minimum data sets? They would be a credible way in which to improve the handling of information, thereby helping those involved in personal and nursing care. I hope that he agrees that, at the moment, there is a real shortfall in the system.
Mr. Heath: I am happy to agree with the hon. Gentleman and I am grateful for his intervention. We need a much fuller assessment of individuals' needs; to try to make such assessments prior to, or at the point of, admission is frankly absurd. What is needed is a period of reflection, in which an assessment can be made and a proper database established and maintained according to the needs of the individual patient. Such a model is not unusual in other areas of care in this country; nevertheless, it has not been espoused in this case.
Having criticised the Government for this basic policy difference—as I said, although I do not shy away from that difference, I do not wish to dwell on it—I congratulate them on recognising that there is an immediate problem. I wholeheartedly welcome the new money that has been provided—an additional £100 million this year and £200 million next year. That
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underlines the Government's recognition of the real problem that exists in various parts of the country. I appreciate that this is significant money; it is not peanuts. However, it must be viewed against the assessment by the directors of social services and the Local Government Association, which has bluntly stated that a £1 billion shortfall exists in the funding of care for vulnerable people across the country. Set against that context, obviously much more must be done.
I will not be churlish. I welcome the money that has been given to Somerset's social services department to assist it in achieving its goals—I understand it to be £726,000. However, it is unfortunate that that share is proportionately less than the staff at Somerset might have expected. Traditionally, Somerset has been rather good at providing investment and the services that people need.
Paddy Tipping: The hon. Gentleman makes a strong point about the allocation of £300 million; some £100 million for the current financial year and £200 million for next year. I understand that the vast proportion of the £100 million goes to the worst performers, which seems to be a change in the Government's position. I hope that the £200 million for next year will be allocated on a more rational and equitable basis.
Mr. Heath: I am grateful to the hon. Gentleman for making exactly my point. We do not know how the money will be distributed next year, but I fervently hope that the Minister will tell us that it will be on a formula basis. There may be arguments about the basic formula, but the present lack of formula is a perverse way of providing incentives and recognising the needs of local authority departments.
What are the causes of the marked reduction in the number of care places available over a short period? A number of problems play a part in the decision to close a home or reduce the number of places. Fear of the impact of the Government's new standards for care homes is part of the equation. The staff of some homes know that such standards will never be met, while others have an exaggerated fear of what may be imposed on them in future and do not want to be part of that game. For some, the new standards represent the last straw that breaks the proverbial camel's back.
One argument is that a more flexible approach is needed that recognises the paramount needs of the residents and the fact that they are not always best served by the closure of a home. Closure of a home is the worst outcome for an individual resident. A more flexible approach may be of great benefit. Another problem is the shortage of staff, not only of trained nurses but of the untrained staff who provide home care in many cases. Such staff, who are traditionally low paid and predominantly female—the two often go together—are asked to take on extraordinarily complex and demanding tasks. Many of us would never wish to find ourselves engaged in such tasks.
The competition with the private sector means that many people are tempted away by easier and better paid billets outside the public sector. The arrival of a new

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supermarket is a disaster for the local care homes and social services providers. A Tesco store opens and suddenly no staff are left to make beds and care for elderly residents in homes. We must recognise that market forces demand that something be done to provide better pay and conditions for the staff in this important sector.
Another element is property values. In my part of the world we have seen those values increasing, especially at the upper end of the market. Large country houses have traditionally been used for residential homes, and the property value of such buildings is vastly in excess of the value of the business. The constant temptation must be to forget about running a business and take the capital sum offered by someone in the City who wants to play at being a squire in Somerset. That is happening more and more often.
The fees payable also constitute a problem. The average increase in local authority fees paid to care homes is around 2 per cent., as against a 5 per cent. average increase for those who pay privately for residential or nursing care. The equation does not work. The problem for care home owners is that they do not have dealings with the rest of the country—they deal only with the social services department where they are situated. As far as those owners know, the local authority is simply mean and not prepared to pay them the rate for the job. That is certainly not the case in Somerset, however, and I am sure that is not the case in the vast majority of social services areas, but because owners see only those with which they have dealings, they do not understand that this is a national issue. Can local authorities afford to pay sustainable fees to maintain the sector and placements that they need?
We often say that throwing cash at a problem is not an answer, but in this case cash is the most important single factor. We must get enough money into the system to achieve sustainable fee levels without losing the other care professionals for which social services departments are responsible. Many departments could be forced to provide cash for care services for the elderly at the expense of other important services for vulnerable people.
We need to find a way of putting more cash into the system, although not preferentially—a point made by the hon. Member for Sherwood (Paddy Tipping). We must not produce fee competition between neighbouring authorities. Some authorities may find that, because they have responded poorly in the past, they have more money in their budget and can pay higher fees to attract staff and placements from neighbouring authorities. That cannot be the answer, nor can it be the answer simply to exhort social services departments to do more. We know from the Local Government Association that three quarters of all social services departments overspent their budgets last year, which represents a total overspend of £183 million. That is a substantial overspend; if I were a council leader, I would be worried about my social services department, or any other department, overspending to such an extent. There is clearly more than a little strain on the system when social services expenditure by local authorities is £1 billion over the standard spending assessment—the Government assessment of what those departments should be spending. The system is not functioning properly.
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What are the answers? There are no easy answers and I do not want to abuse the intelligence of anyone listening to this debate by pretending that there are. However, we should have local sustainable strategies that involve the private sector, the home care sector, the user groups—if that is the appropriate term—the health authorities and the local authorities. I know that in Somerset that is very much part of the way in which the local authority has thought previously and continues to think about dealing with the problems. However, the Government must support sensible strategies that are put forward with the cash to make them work.
To return to a matter that was raised earlier, there is a need to identify what funds will be available in the future. They should be on a formula basis, not a speculative favoured-son basis or any other; they should be fair and respond to demonstrable need. The funding stream should continue into the future.
It is important not to forget that there is a need to respond to the increasing demand for home care and domiciliary care. Many years ago when I was in practice as an optician, I did a lot of domiciliary work and I was not paid a penny for it. There was no recognition of domiciliary work in optics at that time and I was paid as if I was in my surgery. The fact that I had driven halfway across the countryside to see one bedridden elderly lady was neither here nor there to the national health service. It did not care about that, or whether I did it or not. However, I did, and so did many other professionals. We must recognise that domiciliary care is promoted to give people the independence to live in their own home. If we are to promote that, we must fund it properly and recognise the difficulties that it involves. We also need flexibility in the application of care home standards, and the Government would do well to signal that clearly to the private home sector so that some of its worst fears, at this stage, are allayed.
Most important, we need a national review of the capacity that we have—or rather do not have—to deal with long-term care. We must recognise that there is a long lead-in for any changes in that capacity. Homes are not built overnight, and staff are not trained overnight. There is a significant shortfall in capacity, and we need to do something about it nationally, so we need a clear national strategy.
I would love the consensus that exists in Scotland to extend to England and, dare I say, Wales. At present it is not on the table, although it may be. Policies in Scotland sometimes have a habit of eventually seeping their way through the system and become the national policy of the United Kingdom Government. The battle may not be lost. Meanwhile, I urge the Minister to address the matter, which is of desperate importance. I suspect that many hon. Members will recount their own constituency experiences and express that same view.
11.23 am
Hywel Williams: I am particularly glad to be given the opportunity to speak because I wrote Plaid Cymru's submission to the Sutherland royal commission on long-term care. We in Plaid Cymru agreed with the recommendations of the royal commission and many older people in Wales looked forward to the Government acting on its

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recommendations, particularly those on funding. The hon. Member for Somerton and Frome (Mr. Heath) might not have wanted to dwell on the differences between Scotland and Wales and England, but we in Plaid Cymru and, certainly, our colleagues in the Scottish National party see the differences as highly significant.
We were all disappointed when the Government acted because, as we all know, free personal care was introduced in Scotland, but not in Wales and England. The matter of funding is particularly significant in my constituency and my part of Wales. In Gwynedd, we have a particularly high level of residential care for older people, and a relatively higher percentage of older people who may be subject to charging. We also face difficulties because much of the residential care stock is old and requires significant investment to bring it up to standard without compromising the standard of care provided to current and future residents.
Furthermore, levels of personal wealth in my constituency are low. Inherited capital from the sale of a parent's house has a particular significance for the local economy. That inherited capital is, of course, disappearing—I have had visits to my surgeries from constituents who are worried about that because they are passing on to many children shares of the small amounts of capital that they have accumulated.
My constituency also has a large number of care businesses, many of which are run by small, local operators. They are not large businesses or companies; they are often run by husband-and-wife teams. Those businesses are now facing greater uncertainty in their planning, and reference to that was made earlier.
In respect of the royal commission, a partial answer was given to the problem of funding in Wales and England. That partial answer has led to further problems. The system is unpopular—that goes without saying—and one might almost say that it is in disrepute. People who have saved all their lives see their savings reduced and lost to them and their children merely because they are in need through no fault of their own. That is a tax on need.
How does one distinguish—this is an old question—between social and medical care? I taught social care workers for many years in my previous career, and I certainly find it difficult to distinguish between those two types of need. Again, there is the well-rehearsed question: what is a social bath, and what is a medical bath? To ask another question: is putting on incontinence pads a medical matter, and putting on trousers over them a social one?
Mr. George Stevenson (in the Chair): Order. We have a problem with the microphones. If hon. Members move forward to the front row, everything will be okay. However, that does not guarantee that everyone who wishes to speak will be called. I apologise to the hon. Gentleman for interrupting his speech.
Hywel Williams: Thank you, Mr. Stevenson. Being heard is much better than not being heard.
The questions that I was posing are old ones, and clearly absurd. However, they are not the result of professional absurdity. Such questions arise directly
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from the Government's decision to differentiate between the medical and social elements. Deciding on what is a social need and a medical need takes time. Again, that is not the fault of the professionals involved. I understand that decisions have been held up by local panel meetings and constituents have approached me asking to hurry up the process of deciding who should be responsible. However, a system that is intrinsically complicated cannot be hurried up. That is the response that I have had from social services.
As I noted earlier, care providers in my constituency have postponed decisions on large capital investments because of the uncertainty about whether to build on the basis of meeting medical need or social need. Those are real decisions, and extra costs are involved. The effect is that care beds are being lost or denied, and there are delays in discharge from hospital, for example.
We in Wales want a system of care funding that is straightforward, effective and fair. From our point of view, the people of Wales, through our National Assembly, should take the decision on the nature of that system of funding. As Sutherland said, people who are in need should have that need met whatever their personal circumstances. That is the civilised response, and it is also Plaid Cymru's view.
11.29 am
Mr. Kelvin Hopkins: I congratulate the hon. Member for Somerton and Frome (Mr. Heath) on initiating this important debate today, and I am grateful for the opportunity to speak in it. I shall discuss two main issues. I do not expect my hon. Friend the Minister to give way to us today, but I hope that she will take note of what we say and consider possible future changes.
I profoundly believe that long-term care for all elderly people should be free at the point of use, and that we should implement the royal commission's recommendations and move to the Scottish position now. Many Labour Members feel the same as I do, and we shall not rest until that change takes place. I recommend to the Minister the memorandum prepared by Unison the trade union for which I had the honour of working for many years, which has made an excellent case in much more detail than I can go into this morning.
National assistance limits on personal resources were first introduced more than 50 years ago. If the figure used then were indexed forward, it would come to more than £200,000, not the £18,500 that is now the limit below which local authorities pay. That would constitute not means testing but a wealth tax; indeed, I might suggest that if the Government want to raise extra revenue they consider a proportionate, progressive equitable wealth tax that would help pay for long-term care.
The hon. Member for Caernarfon (Hywel Williams) mentioned the problem of inherited capital, which will have a significant effect on the housing market. Sustaining owner occupation now depends to a large extent on inherited capital—on parents handing on the equity in their houses to their children. If that is increasingly taken away as the population ages, it could create housing difficulties as well as long-term care difficulties, with which the Government will have to deal in the longer term.

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The second issue that I shall discuss is local authority homes. My constituency contains three local authority care homes that are currently under threat of closure. The Government, no doubt for very good reasons, have decided to raise the standards required of care homes. Two of the care homes involved were purpose built, and I know that they are extremely good, because I have visited them. Indeed, in one of them my late mother-in-law lived for some time and was very happy, receiving excellent care from permanently employed, properly paid, trade union-organised local authority staff. I want those homes to remain open and in operation. However, if the new standards are imposed and they have to be modernised and upgraded without that being fully funded by central Government, the local authority will not be able to afford it, and will effectively be forced to close them and to put more of their long-term care residents into the private sector instead of in the public sector homes available at present.
We have already heard about problems with long-term care in private homes, and the fact that some homes are finding it difficult to make a profit. Whether profit is appropriate in the case of such a service is another issue, but they are finding it difficult to sustain those homes financially and are having a hard time. Property prices are rising, and some see the advantage of selling off, possibly for conversion to owner occupation, as that would be a more profitable use of their resources.
I ask the Minister seriously to consider supporting local authorities that may be forced to close their homes because they cannot afford to modernise them in line with the requirements of the new standards—or, alternatively, to reconsider the care standards. Some purpose-built homes that are still reasonably good—the homes in Luton are extremely good—do not quite match the required standards. We could build new homes to the required standards but, for the time being at least, keep the old homes, as they are, without pressing local authorities to modernise them—in effect, to rebuild them—simply because the rooms might be too small. If and when those standards are imposed on the private sector, the costs of meeting them would be too high, and many private homes would therefore have to close. The homes would be unprofitable, and they would be sold. Indeed, there is a desperate shortage of rented property in my constituency, and the private sector could do very well by selling off its homes or converting them into flats for owner occupation. That would lead to a crisis; a shortfall in care home provision would be created in my constituency.
I therefore make two pleas to the Minister: look again at free long-term care, and give a little support to local authorities that might be forced to close their homes. Although I am publicly opposing such closures, I also appreciate that my local authority faces a desperate financial problem.
Mr. George Stevenson (in the Chair): Many hon. Members wish to contribute to the debate, so I ask those who are called to speak to be as brief as possible.
11.36 am
Dr. Andrew Murrison: The hon. Member for Somerton and Frome (Mr. Heath), who represents a constituency that neighbours mine, is extremely lucky,
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as Somerset has been marked out for special funding from the £300 million package that the Government announced on 9 October 2001. That announcement did not carry with it criteria for the award of additional funding, and as Wiltshire has done rather badly out of it, I should be grateful for the Minister's clarification on that matter.
Earlier this year, my Wiltshire colleagues highlighted the inadequate settlement for education funding in the county, and it appears that similar treatment is now being meted out to the other end of the spectrum—the elderly people of Wiltshire.
The hon. Member for Somerton and Frome and I share an interest in the Royal United Hospital, Bath, and I welcome the additional money that has been allocated to Gloucestershire, Somerset and Bath, in so far as it might ease bed blocking at the RUH.
Wiltshire has the longest waiting list for residential and nursing home placements in the south-west that are funded by local authorities, despite the fact that the county's health authority funds 50 places through transfer of funds to the county council, and also that a joint review conducted 12 months ago said that Wiltshire's social services were among the nation's best. I fear that additional funding for neighbouring counties and authorities will, paradoxically, have a bad effect on poorly resourced Wiltshire because neighbouring authorities will be allowed to buy up services from Wiltshire homes and Wiltshire's elderly will be adversely affected. I urge the Minister to re-examine the case for including Wiltshire in the list of 50 authorities earmarked for additional funding on 9 October, because the county's elderly deserve a better settlement than the one that has been offered.
Several hon. Members rose—
11.37 am
Dr. Vincent Cable: The competition among hon. Members to speak reflects the widespread concern about the matter under discussion.
The story that was told by my hon. Friend the Member for Somerton and Frome (Mr. Heath) reflected the experiences of all hon. Members. I wrote a letter to the Minister a couple of weeks ago describing the problems of local social services in relation to spending, such as spill-over in terms of cuts in provision, bed blocking, and upstreaming local hospitals. My letter crossed in the post with the Minister's offer of more funding, so I do not wish to pursue that point.
Instead, I want to highlight another aspect of the problem that has come to the surface as a result of a lead story that appeared last week in, I think, the Sunday Express. It referred to what it characterised as a scandal in a residential home in my constituency. The home is called Lynde House, and it is part of the Westminster Healthcare group. I want to refer to the case, as it serves to illustrate some of the broader problems that are being experienced in the private sector.
The institution, which is part of a large group, is in many ways at the top end of the market; the typical fee is about £660 per week, as it is very well appointed. It appears to be a luxurious home, and it is, no doubt, a very good one in many respects. However, I started to receive serious complaints several months ago, and I

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have now received more than 20 well-documented cases. They were discussed, often in highly emotional terms, at a public meeting that was organised by a local parish priest. The complaints resolved themselves into two types. First, there were complaints about the treatment of physical conditions. For example, elderly people with incontinence problems were left for long periods without being changed and did not get a response when they rang the bell. The underlying problem was that described by my hon. Friend the Member for Somerton and Frome. There is a serious problem in the labour market, with shortages of nursing and other care staff. Staff are badly paid and poorly motivated. There is a high staff turnover and employees have little commitment. Within a context of highly deficient and unsatisfactory management, the elderly people in the home suffered.
Secondly, when people and their relatives complained and endeavoured to make the problems known, they met a rather unsympathetic management. In some cases, very old ladies were expelled or suspended from the home, or required to sign letters promising not to complain in future. I was confronted with the rather chilling phrase that these old ladies were "destabilising management". That illustrated the profoundly unsatisfactory culture that had developed, and it deserved to be publicised.
In terms of the broad lessons to be learned, I highlight two issues and would like to hear the Minister's response to them. First, although inspection will be improved under the new care standards system, the current system rests heavily on the work of health authorities and their inspection units. The case that I have mentioned was difficult to deal with because the health authority had inspected the home and given it a clean bill of health. I have wondered why, and I suspect that it might be because inspection is rather formal. It involves a lot of ticking of boxes and physical measures, but does not get to grips with the quality of care or intangible things such as problems with client-management relations, which in this case were not picked up in the inspection, despite being on the record. It is also possible that because the inspection units work with the local providers rather than exercising tough, independent assessment the relationship becomes too cosy.
Either explanation may be correct, but it is clear in this case that the inspection system failed. I have asked the chairman of the health authority, who is being very co-operative, to investigate the matter, but I think that the way forward is to have an independent overview. Someone independent of the provider and the health authority should be brought in to examine what is happening and to evaluate the complaints and the way in which they have been dealt with.
The second general point, which goes to the heart of the points made by my hon. Friend the Member for Somerton and Frome, is that such situations arise largely because of the problems of market supply and demand. There is a problem with contracting supply. Those who remain in the market, such as the home that I have described, are able to charge considerable fees. They can cut corners because people have few choices
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and they can bring pressure to bear on complainants because plenty of other people are willing to come there. That is the cruel logic of supply and demand.
I do not wish to aggravate the problems in my area by creating such a stink that the home is obliged to close. We need it, as we need other residential homes, but I want improved quality, as I am sure do the relatives. That will come only when there is improved supply. I share the views that have been raised by many hon. Members that it is crucial to examine care standards, not to suffocate but to improve the supply of accommodation—whether that comes through the public or the private sector.
11.43 am
Paddy Tipping: The debate is important and timely, and concern has been expressed by many hon. Members in the Chamber this morning. The hon. Member for Somerton and Frome (Mr. Heath) described long-term care in Somerset as being in crisis. I am not sure whether long-term care in Nottinghamshire is in crisis, but there are certainly real problems, especially in the nursing home sector. North Nottinghamshire health authority reports the loss of almost 150 beds and Nottingham health authority reports the loss of 150 beds this year. That is 300 beds lost from the stock, with two consequences. First, when a nursing home closes immediately, the care that is given to the frail people who are transferred to another home is not appropriate and leads to severely diminishing life chances. Secondly, the choice that is available to elderly people and their families diminishes as the stock reduces.
There are three pressures on the nursing home sector. The first is the general increase in costs due to improved standards; the second is the minimum wage, which I support; the third is the need for extra qualified nursing support in the nursing sector, which involves a demand issue—some nursing homes have not been able to recruit the necessary staff at the right price.
Those issues also relate to the residential sector. Many families face financial difficulties in respect of so-called third-party costs. As the hon. Member for Somerton and Frome said, local authorities increase their payments for residential care by roughly 2 per cent. a year. The real increase in cost has been far greater than that, and relatives have been asked to meet the gap by entering into contracts, the terms of which have varied. Put simply, many families are struggling severely to meet their share of the increase in costs.
I welcome wholeheartedly last week's announcement of £300 million—£100 million in this financial year and £200 million in the next. Will the Minister spell out how that allocation has been made, especially in this financial year? Having spent some time looking at the figures, I can see that cities such as Birmingham and Sheffield have done particularly well. Clearly, they have real needs. However, I have an impression—I put it no more strongly than that—that the top 50 worst performers are being rewarded, while those local authorities that have worked hard in the past, and have not talked of crisis, have not been adequately rewarded.
How will the £200 million for next year be allocated? It is a question of equity. It is important that elderly people across the country are treated with fairness, and

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it cannot be right if local authorities that have not achieved are rewarded. Indeed, that runs against the bulk of Government policy.
The debate is primarily about residential and nursing care, but the real issue is domiciliary support. Good domiciliary support costs a great deal. The cost of providing meals, home helps, IT and aids and adaptations means that it can often be more expensive to keep a person in their home than in residential care.
In real terms, significant sums of money are going into public services—an increase of between 5 and 6 per cent. in the funding for the national health service and for education each and every year—but social services departments are badly stretched. They do not have that amount of growth; they have problems with their budgets. There is such a problem in Nottinghamshire, and I want assurances that there will be adequate funding so that the problem does not become a crisis.
11.49 am
Mr. Paul Tyler: I entirely endorse the point about domiciliary care made by the hon. Member for Sherwood (Paddy Tipping), but in the interests of brevity I shall not go over it again. I congratulate my hon. Friend the Member for Somerton and Frome (Mr. Heath) on his comprehensive introduction to the debate, in which he said, "We all have an interest in this subject." That statement is abundantly true, and it lies behind the consensus that has been evident during the debate.
I declare a personal interest: my mother will be 100 years of age in a few weeks. She is, as one would expect, in long-term care. I should like to take the opportunity to pay tribute to the way in which she has been looked after in a private home, which has been fantastic.
I endorse the concerns expressed by my hon. Friend the Member for Twickenham (Dr. Cable), but it would be wrong not to put on record that the vast majority of people who care for the elderly, be they private owners of care homes or be they their staff who, as he pointed out, have a difficult job, are trying, in the most difficult circumstances, to look after our elderly in a responsible and skilled way. That is the kernel of the problem, to which I shall return later in the debate.
I want to endorse and reinforce some points that were made earlier. It is a demographic fact that longevity is part of the problem, and that is especially true of Cornwall. Not only do we have a wonderful climate, which is why my mother will soon be 100, but we have many people, some of whom will have retired from the constituencies represented here today to the most beautiful part of the UK. We therefore have a disproportionate number of elderly people who require long-term care in Cornwall. We also have many large properties in coastal and seaside resorts, which is something that applies to other parts of the country, and they have traditionally been seen as appropriate—my hon. Friend the Member for Mid-Dorset and North Poole (Annette Brooke) will agree with this point—for conversion into care homes. That combination of demographic and physical factors has resulted in a concentration of homes that is becoming a problem. The problem is especially acute where local authorities find themselves at a considerable long term disadvantage, which was a point made by the hon. Member for Sherwood.
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The 2 per cent. increase in funding, which nowhere near meets the cost, will, if we are not careful, be year on year. Those who pay privately for care cross-subsidise those who do not. Such people may feel that that is an unfortunate fact of life, but it is creating frustration and resentment, which we can well do without. Those who run private homes are desperately trying to make ends meet, but they are finding it difficult to meet that objection with a logical argument. Neither they nor social services departments have created that situation; it is the result of the Government's funding. However, I shall not rehearse all Cornwall's problems because they are similar to those that were mentioned earlier.
As far as I can see, there are no villains to the piece; they are all victims. Care home owners clearly have a difficult task and most are dedicated to the work that they do. Care homes are not seen by most of their owners as simply a profit-making commercial enterprise. They generally entail a personal commitment. Staff, to whom I have already referred, now find that people with less skill, dedication and commitment than themselves can, as my hon. Friend the Member for Somerton and Frome pointed out, stack shelves in a supermarket at a better rate of pay and with fewer difficulties in terms of conditions and responsibilities. Staff are having intolerable pressures put upon them although they are doing a difficult job. Training and career development are important, and it was interesting to hear from the hon. Member for Caernarfon (Hywel Williams), who has obviously been involved with those issues.
We must ensure that there are greater career opportunities for carers. We all know councillors for whom this problem has caused genuine and terrible dilemmas. Finally, and most importantly, there are the residents themselves. For all those people, it is critical that we try to remove the endemic, persistent and consistent uncertainties that have been there for so-many years. For everyone concerned, but in particular the vulnerable residents, I hope that we can ensure a degree of certainty during the next couple of years.
I hope that the Minister and her colleagues will look over the border to Scotland to see how our colleagues and her colleagues are working together to achieve a more equitable solution. However, we cannot wait too long.
11.54 am
Mr. Paul Burstow: We have had a good debate and I am grateful to my hon. Friend the Member for Somerton and Frome (Mr. Heath) for enabling us to have it. We need to explore the issues that he and other hon. Members have raised and we must put some questions to the Minister.
The message coming from the contributions made today is that we have experienced an extraordinary loss of capacity in the care sector outside hospitals, and that is why we now have problems in hospitals. There has been a lack of understanding of the consequences of a number of policy initiatives over the past five years, if not for longer. On the one hand, there are serious staff shortages with two out of three social services departments reporting staff shortages and many care homes struggling to compete with the supermarket down the road because they cannot afford to pay their

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staff as much. On the other hand, there is a physical shortage of capacity, particularly in the care home sector. My hon. Friend gave the figures on that.
The problems caused by the combination of those two factors have been exacerbated by the new standards that have been introduced. They are welcome but the cost consequences of complying with them have not been followed through. When care home managers examine the standards, they will realise that adjustments must be made to their properties. When they work out the cost of them and see that they will have to have fewer people in their homes with a lower fee income, they will be even less able to repay any loans that they receive to make the changes. Their bank managers would laugh them out of the room, so they will not even go to see their bank managers but will investigate the retail possibilities that might result from closing the home and realising a rental or other income. That is why, in some parts of the country, the issue is not to increase fees to retain capacity, but to encourage people back into the market.
For example, in Kent and Somerset many homes have gone—they have been boarded up and sold. We must recover capacity in those areas or we shall be faced with the prospect of social services departments recruiting overseas, with the prospect of elderly people being exported overseas to be cared for. Increasingly, that is the prospect in Kent and other parts of the country.
My hon. Friend the Member for Twickenham (Dr. Cable) rightly referred to the concern about the result of those pressures on care for individuals. There is strong evidence of a powerful correlation between low levels of training and abuse in homes. There is much research evidence of that in the United States and equivalent evidence in this country. We must recognise that part of the problem is the insufficient training of staff who are not as skilled as they should be in treating people with dementia. My hon. Friend the Member for Somerton and Frome referred to the difficulties of dealing with people with dementia and to the need to provide appropriate care.
That brings me to the roll-out of the "free nursing care" that started on 1 October and that will have the unwelcome consequences that the Government have not foreseen in setting their objectives for tackling bed blocking. Not only was that policy introduced at breakneck speed—the final guidance was issued on 25 September, which left staff in the NHS three working days in which to implement the final version of the guidance—but not all the documentation was available at that stage.
There is concern that the guidance will create perverse incentives. Those with the highest needs will pay less because the cost of their nursing care will, appropriately, be picked up, while those with the lowest needs will pay most. That may lead places with poor practices that drive up dependency being rewarded because they may receive extra money for nursing care because they do not provide the social and other activities that promote independence.
My hon. Friend the Member for Somerton and Frome referred to dementia care. People with dementia do not simply turn up in nursing homes, but the Government's work book for rolling out free nursing
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care shows that people with dementia could be banded at the high-need level and receive free nursing care worth £110 a week. What will happen if, as surveys have shown, people with an equivalent level of need are in residential care homes? Will they be made to up sticks and move to a nursing home with all the consequences involved, or will the rules be flexible enough to provide free nursing care for people in residential care homes?
Will the bands introduced for free nursing care be uprated annually? If not—we have already heard that self-funders' fees increase by 5 per cent. a year on average—the gap will start to widen again. A greater proportion of care, as well as accommodation costs, will have to be paid for. Will there be an annual uprating, and will it take into account regional variations such as weighting allowances and the cost of regulation? The fact that the regulatory system will continue to move forward and change must also be reflected.
I have a question relating to the roll-out of free nursing care. What is the appeals mechanism? At the moment, it is very unclear what it will consist of, and it would help if the Minister could spell out how people will gain access to it and whether support from independent advocates will see them through the process. Often, we are talking about people who, because of their condition, are the frailest and least able. They need support to be able to get what they are entitled to.
On capacity and free nursing care, a care home owner who runs a small nursing unit and has a number of people banded in the medium care band will need to have a registered nurse in the home all the time. That will cost a substantial extra sum. To cover the cost of one nurse, 20 to 25 residents will need to be in that band and receiving moneys from the NHS. If such an owner has fewer residents in the medium band, how on earth will he be able to pay for his obligation to provide a registered nurse all the time? The Minister needs to clarify how we are to ensure that smaller nursing homes, which will be vital in dealing with bed-blocking issues this winter and beyond, are not suddenly put out of business by an initiative that is well intentioned but perhaps not fully thought through.
The capacity issue brings me to the final set of questions. Last week's announcement of an extra £200 million in a full year is very welcome, but we need to be clear where the funds are coming from. Is the pot of money new, or is it to be taken from the £900 million for intermediate care that has been talked about on numerous occasions? It would be nice to know whether the funds were new or had been taken from contingency reserves or somewhere else.
What is the target in respect of bed blocking? Is it to make available 1,000 beds by the end of the winter, or 1,000 beds a day to the end of winter? The target is unclear and it needs to become a lot clearer, so that it is not missed by the local authorities that are in the frame.
That brings me to the 50 local authorities that have benefited from the special grant that will come their way. It is not merely a question of rewarding the local authorities that are the poorest performers, because much of the money is being targeted on health authorities with trusts that are not delivering. The announcement has triggered a response from care home owners across the country. They are saying, "Isn't it

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time that our fees increased—not next year, but now?" They are giving notice to their local authorities that they want their fees to go up now, and that if they do not, they will refuse to continue to take state-funded places. Indeed, that is already happening in York, and is causing great concern as a result.
Let us consider the case of an authority that does not receive the extra cash but neighbours one of the 50 authorities that benefit from it. That authority will see its neighbour jacking up the rates that it is prepared to pay, but it will be unable to pay the same rate. It will no longer be able to afford to place people in the homes in which it used to place them. Suddenly, it will be a bed-blocking local authority. However because the local authority that receives the money this year will have an on-going commitment to fund the person that it placed in the nursing home, it will ask the Government for the full amount next year. So although the £200 million is welcome, it will be fully committed to this year's expenditures. Any other local authority that wants to do well in future will need extra resources to deal with its capacity problems.
If we do not have the capacity to provide long-term care in Kent, Somerset and the other places that hon. Members have mentioned, the year-round gridlock in our system will continue to get worse. Private investors will not come back into the sector to reopen homes and establish new care facilities. Will the Minister guarantee that long-term investment will be made, and not just year by year by the tap being turned on and off? Local authorities and the private sector need to know that for three, four or five years funding will be provided so that they can invest in guaranteed delivery.
12.4 pm
Mr. Simon Burns: I welcome the debate. Every speaker has referred to long-term care as being a problem or as being in crisis. Both those propositions are true, partly because of changes in the way in which society and individuals want to provide care for elderly members of their family.
Outdated legislation provides the framework for a policy that has moved on dramatically. I refer, of course, to the National Assistance Act 1948, which laid down the definition of health and social care at a time when there was no emphasis on providing domiciliary care. There were long-stay hospitals where the elderly, with appalling quality of life, were left to languish until they died. That was a national disgrace. Fortunately, in the past 50 years, society has become far more civilised and caring in its provision for elderly people. Community care has developed, which I strongly support, and there is an emphasis, when it is feasible, on domiciliary care that allows the elderly to remain in their own home.
We have also seen the development in private residential homes of a home from home for those elderly who are so frail that they cannot live in their own home. That has created significant problems, partly because, following the 1948 Act, people have been subject to means testing. We may have missed an opportunity to address the funding of residential care when the Government first set up the royal commission on long term care. For many years there has been resentment that people who have been thrifty and put aside money for their old age, and who can no longer live at home and
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must go into residential care, must be financially responsible for their own care until their assets are reduced to £18,500. Yet, on the other side of the coin, the state pays for care for people who have not been thrifty and made provision for their retirement. In fairness, I should point out that people who have failed to make provision for their retirement have not always spent the money as they went along. It is not always that they have not been thrifty; there are people who were unable to put money aside due to economic or physical circumstances. However, a group of people exists who were not thrifty when they could have been, which causes resentment.
What can one do to ensure that the system works? The policies on which the Conservative party fought the last election offer an alternative positive step forward. First, we propose a voluntary insurance scheme, which will be part of the ethos of the responsibility of the individual. If that ethos were established at the start of people's working lives, the premiums that people had to pay would be so negligible that they would not mind paying the money. It would be a voluntary system whereby they could bypass the means test. When they reached retirement age and needed residential care, they would be able to draw on the insurance policy and protect their assets, which they could then pass on to their children or grandchildren if they wished.
The other alternative is a scheme put forward by my hon. Friend the Member for Woodspring (Dr. Fox) to create a long-term care fund, into which individuals could put a lump sum. It is estimated that the lump sum, at current prices, would be about £25,000 to £30,000. If people did not need those funds for long-term care—75 per cent. of people in this country do not—the asset could be passed on to their children or grandchildren for their long-term care. Both proposals are worthy of consideration because it is unacceptable that in the lifetime of this Government 160,000 homes have had to be sold by individuals or families to pay for residential care.
I mention briefly the problems of free nursing care, which have been mentioned by many hon. Members. Many people feel betrayed by the Prime Minister's announcement, which was made, typically, before a general election, that from 1 October this year nursing care would be free. In the Committee that considered the Health and Social Care Bill, the official Opposition had an agreement with the Government that we would accept the policy of not changing the rules and regulations on residential care because we supported the provision of free nursing care. We believed that that was the quid pro quo.
We now feel betrayed, as do many organisations and individuals, because we took what the Prime Minister and the Government said at face value. We believed that the Government were sincere about providing free nursing care for all from 1 October. What a sham that has become. It is now apparent that nursing care is not free for all. There is the banding system, and the definition of nursing in small print excludes significant sections of the community that most normal and reasonable individuals would consider to require nursing. For example, people who suffer from dementia and Alzheimer's disease will almost certainly not receive free nursing care because the Government have

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categorised their care as personal care. That is a disgrace and a betrayal, and the Government should look again and provide what they promised.
I also draw attention to the problems of the residential home sector. Beds are withdrawn and closed down for a variety of reasons. As many hon. Members have said, there are problems with funding and self-funders pay a 5 per cent. increase in fees each year, whereas local authorities pay less. Local authorities effectively use their position in the market to force contracts on residential care home owners. That is partially because of the severe strain on the social services budget. A number of homes have been put out of business because they cannot afford to continue. Similarly, legislation on the standards of care expected of homes causes a severe problem for existing homes—particularly small homes—and will have an impact on those thinking of building purpose-built homes. I question some of the small print on the size of rooms and other standards that are being demanded, and I urge the Minister to examine that matter. In the light of our experience and of what is expected to happen, will the Government consider whether more common sense and flexibility can be introduced into the system?
Mid-Essex, where my constituency is located, offers a classic example of the kind of situation that must be avoided. The number of beds in the area is shrinking; homes in Chelmsford and the surrounding area are regularly closing down. Ten years ago, there were enough beds to meet the need for residential care, but that is no longer the case. As a result, elderly family members are having to move away from the area to find a home. That causes them grave distress, because they may have spent their entire life in the Chelmsford area, and they may not want to travel 30 or 40 miles to an unfamiliar area. It also puts a strain on relatives, as they have to travel further to visit. In short, it is an unsatisfactory situation that must be addressed.
I will now conclude as time is running out, but I urge the Minister to listen carefully to all the points that have been made across the political divide during this important debate, and to be prepared to think again, rather than simply to tell hon. Members that everything is fine, that the Government are wonderful, and that the rest of us have got it wrong.
12.16 am
The Minister of State, Department of Health (Jacqui Smith): I congratulate the hon. Member for Somerton and Frome (Mr. Heath); the debate has been useful and interesting, and I agree with him that it deals with an important issue. We live in a society in which increasing numbers of people live to an advanced age. One in five of us is over 60. During the next 25 years the number of over-80s will increase by 25 per cent., and the number of over-90s will double. Those figures are to be celebrated; we should take pride in them. I want to take this opportunity to wish a happy birthday in the coming weeks to the mother of the hon. Member for North Cornwall (Mr. Tyler). Older people are not a burden on society, and they must not be characterised as such; they are a resource of wisdom and experience.
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However, our ageing society creates a new set of challenges so we must modernise the present system of care. I agree with hon. Members that that system can be confusing, unfair and unresponsive to individual needs. The Government have set out to address the matter. As a result of the changes announced last year in the NHS plan, older people can now have greater confidence in the ability of health and social services departments to deliver the services that they want in the quantities that are required and of the right quality.
Several hon. Members have raised concerns about the capacity of the care home sector. I point out to the hon. Member for Somerton and Frome that, although the Government do not underestimate the importance of that matter, the figure of 50,000 in relation to the loss of beds is incorrect. It is also necessary to bear it in mind that although some beds have been closed, others have been created, because some homes have expanded their provision. In 2000, there was a net loss of around 7,700 independent sector places, according to a recent report published by Laing and Buisson, is an expert in that area. It is, however, also interesting that Laing and Buisson reported that
"the continued failure of any really major wave of closures to materialise by the end of 2000 bears witness to the survival power of small businesses in this sector."
That is encouraging, although, as I will explain, the Government are not complacent about the situation in respect of care home capacity.
The reduction in capacity can, as some hon. Members have pointed out, be consistent with a policy of promoting independence. Everyone—including older people—wants to keep people out of institutional care if that is possible, and I note encouraging figures that show that 5 per cent. more households received intensive home care packages in 2000 than in 1999. In Somerset, recent indicators show that more older people have been helped to continue to live at home. However, we must ensure that such a change is planned so that alternative services are available. That is why the Government have already provided significant additional resources for social services and why the further cash injection of £300 million was made for this year and next year, details of which I shall explain later.
As part of the implementation of the NHS plan, local authorities and health authorities are now required to work with local independent sector providers to determine nursing and residential bed requirements and to agree a strategy to remedy shortfalls. The Government are undertaking a study of the supply of residential and nursing homes in England and are examining future requirements, profitability and closures. My predecessor brought together a strategic commissioning group that has examined improvements in commissioning. We need to maintain capacity and encourage diversification and innovation, so that we can provide options for adults who need care and support.
To that end, in line with the £300 million investment, we recently published an agreement with local government, the NHS and independent sector providers of health and social care, and housing services. That agreement, "Building Capacity and Partnership in Care", sets out principles and practices that can be followed at a local level. Acrimonious disputes between councils, which are commissioning and paying for services, and independent providers, particularly of

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residential and nursing homes as well as domiciliary services, are not good. The people who suffer are local people who need those services. They are at the centre of our worries today, which is why I can understand the distress caused by care home closures. Better emphasis needs to be placed on commissioning at a local level. We must take a fresh look at how national and local government, the NHS and independent sector care providers can work and plan together to the advantage of the service user. Real collaboration will result in standards rising and better outcomes for services. The agreement that we published last week is intended to help that process.
Hon. Members referred to national minimum care standards. The development of those standards is part of our overall reform to modernise the regulatory system for social services and nursing homes. The hon. Member for Twickenham (Dr. Cable) emphasised the need for a coherent and regulatory inspection system. While recognising the need for standards, the hon. Member for Luton, North (Mr. Hopkins) expressed worry about how such standards would be implemented.
The national minimum standards for care homes for older people were published in March. They will promote better quality care and help to stop abuse by grounding practice in the principles of dignity, choice, privacy and respect, which we all agree are important. They will guarantee residents access to an effective complaints procedure and ensure that they are cared for by trustworthy and reliable staff who are properly trained for a difficult and sensitive job. Those standards were consulted on extensively. We listened to the concerns of providers and produced sensible standards that will give providers a reasonable time to adapt and achieve the support of national organisations that represent consumers and providers.
We made several specific changes to the proposed standards in response to the concerns that were raised. I am confident that such decisions will ensure that necessary improvements in the quality of care homes will be achieved smoothly and that stability and sufficient capacity are maintained.
However, it is also important to communicate effectively the reality of what the standards will mean for care homes. Some slightly exaggerated claims have been made in some areas. I take responsibility for ensuring that we communicate with care home owners because, in introducing the standards, we need to maintain high quality and ensure that the good care homes to which hon. Members referred maintain their it capacity through the change.
It will be for the National Care Standards Commission to decide in the particular circumstances of each home whether that home conforms to the standards necessary to meet the assessed needs of its residents. The focus of that commission will be to work with providers to help them meet national standards. That is important. Through the process we need to maintain capacity and the good work done in our care homes.
Richard Younger-Ross: Will the Minister give way?
Jacqui Smith: No, because I am short of time.
Hon. Members referred to last week's announcement on extra funding for bed blocking. We recognise that more money is needed in the system to make a reality of the right quality of care for older people at the right time and in the right place. That is why the extra £300 million announced last week, which is in addition to the £900 million identified for intermediate care, is aimed at stabilising the care home market, which may mean that local authorities need to reconsider the fees that they offer in partnership with their independent and voluntary sector partners. We aim to attack the bed-blocking problem and ensure that developments take place in the context of improving services for older people, as we set out in the national service framework for older people.
We are focusing £45 million of this year's £100 million on the 50 councils that need greater help. Another £45 million will be distributed to the other 100 councils on the basis of the standard spending assessment, and £10 million will support other initiatives to support and promote change for the good of the users of the system.
My hon. Friend the Member for Sherwood (Paddy Tipping) and the hon. Member for Westbury (Dr. Murrison) expressed anxiety about our decision to target that money. The issue is not fair shares for councils but tackling areas in which users of the service are disproportionately affected by the problems. That is why we focused on areas in which people are suffering the most, and we were right to do that. The conditions surrounding the money that we are allocating to the 50 councils that are receiving the extra help are tight. A target will be agreed for reducing delayed discharges from hospital, and councils will need to take clear steps to improve their partnership working and strategic planning.
As for the £200 million for next year, we have already said that no local authority will receive less than it received this year, but for the reasons that my hon. Friend the Member for Sherwood gave, we need to keep under review how to promote best practice in the system and ensure that we make the changes that our constituents want.
On 1 October, we delivered on our commitment in the NHS plan to provide free nursing care for all, with £100 million worth of investment this year. From that date, no one need pay for the care of a registered nurse in a nursing home—care that in other settings is already provided free by the NHS. For people who were already receiving nursing care in other residential care settings, it is the continuing responsibility of the NHS to ensure, as before, that that NHS provision is free. We have removed an anomaly by ensuring that care provided by a registered nurse in a nursing home is free, and we are moving away from a means-tested system of nursing care to one that is based on assessed need. Clinical need, rather than income, is the determining factor in deciding the band of nursing care in which people are placed. That will be introduced alongside other measures designed to make the system fairer—a 12-week property disregard, and money for local authorities to introduce a deferred payment scheme.

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In response to points made about Scotland, we should have this debate in the light of reality. The hon. Member for Caernarfon (Hywel Williams) suggested that changes had already been made in Scotland; they have not. We have delivered on our commitment to introduce free nursing care in England. Changes are still under discussion in Scotland. It is right in a devolved system—
Mr. William O'Brien (in the Chair): Order. I now call the hon. Member for Aberdeen, South (Miss Begg).

Energy Strategy (Scotland)
12.30 pm
Miss Anne Begg: I am delighted to be here to discuss the Government's energy strategy review in Scotland, and pleased that I have secured an Adjournment debate on such an important subject.
The subject is huge and could easily fill an hour and a half of debate, but we have only half an hour. It is probably too big for me to do it justice in that time, so I will begin by saying what I will not be talking about, because the energy strategy review has many aspects and there will not be time to cover them all. I do not want anybody to leave the debate thinking that I am not aware of all the issues. For instance, I will not speak about the future role of nuclear power in Scotland, although that is an important issue. Nuclear power stations will soon be nearing the end of their cycle, and decisions will have to be made about what will replace them and whether new stations will be built. That subject would be enough for an Adjournment debate, and may be picked up by another hon. Member. I will not be saying a great deal about electricity generation, transmission or supply, either—the mechanics of how electricity gets into our homes. That, too, is a big issue and is important in any strategy review. Nor will I talk about the future of coal, or about what will happen to the coal communities that are still struggling with difficulties created by the downturn in that industry.
In such a short debate I want to focus my attention, and as I am an Aberdeen MP it will come as no surprise that I will concentrate predominantly on the oil and gas industry, and on the role of Aberdeen. The oil and gas industry will be crucial not only in the energy strategy for Scotland and the rest of the United Kingdom, but for Aberdeen's economy, which is vibrant thanks to the prosperity created by the industry. It is vital to how the future of Aberdeen develops. Any energy strategy must take into account not only the short-term but the long-term needs of the industry. Aberdeen has an important part to play in the long-term future of energy needs, which will be predominantly concerned with sustainable and renewable energy. My contribution will therefore be made in two parts, examining first the role of oil and gas now and in the near future, and then Aberdeen's role in future energy needs through renewables.
First I will deal with oil and gas. My advice to the Government is: do not write them off. Much has been written in the newspapers recently about the idea that that industry is on a downturn and nearing the end of its life. I remember when I first went to Aberdeen to begin university in the early 1970s and the oil industry had just arrived. At that time the lifespan of the industry was declared to be 10 years and at the most 15—or if we were really lucky it might last for 20 years. We were told to make the best of it, because prosperity would not last. Some 30 years down the line the oil and gas are still flowing. As many reserves on the UK continental shelf in the North sea are known about now as in the mid to late 1970s. There is as much oil for recovery there as there was in the original 1970s projections, even without taking into account the exciting developments west of Shetland.

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An exhibition is held biannually in Aberdeen, and the mood at the recent 2001 Offshore Europe exhibition was incredibly upbeat and positive. The elaborateness of the displays showed that the industry was in good heart, and some operators and contractors made spectacular presentations. That is a good barometer indicating that the operators and contractors in the oil industry feel that there is a future in the North sea.
The oil industry is still a major employer in the Scottish economy. Various figures are bandied about concerning the numbers employed. The submission from the Scotland Office to the energy review mentions 100,000 jobs directly or indirectly related to the industry. Those employed directly in the oil and gas industry, however, total 41,000 this year. That is down from the figure for those working in the industry in 1996, which was 46,000. According to the oil and gas prospectus—the 2001 update produced jointly by Aberdeen city council and Aberdeenshire council—total employment in the oil and gas industry is projected to drop to 37,000 in 2011 and to 32,000 in 2016. Fewer people will be working in the industry, but I contend that 32,000 jobs still form a sizeable part of any economy.
The interesting development, however, is in the numbers working offshore. That figure is due to drop even more severely than total employment. This year, about 18,000 people work offshore on the UK continental shelf—down from 21,200 in 1996—and by 2016 the figure is projected to drop to 12,000. Why is the drop in the number of people working offshore worse than that in the oil and gas industry as a whole? It is partly caused by new technologies. As those come in, and as fields mature, fewer people are needed to work on the inhospitable terrain of the North sea oil platforms. In fine weather, working on a platform is very pleasant, but in less fine weather it is a hard job. However, modern platforms are quite luxurious and a lot better than the original ones. I have visited the Miller platform, for which I thank BP. It was an experience like no other in my life. If anyone here has never been offshore, I would advise them to try it.
The number of fields in production is increasing. There were 87 in 1996, and the projection for 2016 is 115. Again, that is all to do with new developments and new technology. There have been improvements in oil recovery, in the North sea in particular. New technology is such that fields that were previously difficult to operate are now in development. We knew that oil and gas were there, but could not get them out until now. The rise in oil prices has made it possible to recover some fields that were in mothballs—if I may use that term. I am wary of mentioning particular operations in case I miss some out, but I was recently at the interesting inauguration of the Franklyn Elgin field by TotalFinaElf. That was a difficult gas field to develop because of the heat and pressure that the gas was under.
When I did my Industry and Parliament Trust with Chevron in 1998, the price of oil was as low as $10 or $12 a barrel. Decisions had to be made about a difficult field, the Clare field, which was a joint venture between Chevron and several other operators, predominant among which was BP. I sat in on the meeting at which they decided not to proceed with that development. It was a sad day because years of work had gone into the project, but the oil price meant that it was unsustainable
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at the time. I am glad to say that, because of the higher price of oil, the Clare field is now going ahead. Those are just two examples, and they are not the only ones, of how difficult marginal fields can now be exploited.
We now have better recovery of oil and gas. Where fields have been decommissioned or are nearing decommissioning, operators such as Talisman have come in and bought up some of the licences. Such operators are now recovering oil and gas—especially oil—from areas that were thought to be nearing the end of their lifespan. The lifespan of many fields has been extended.
Mr. Alistair Carmichael: Does the hon. Lady agree that there is a prospect of the industry's provision of jobs in constituencies such as mine having a particularly long tail if we can get into the decommissioning market? If we can bring installations back on shore and decommission them in an environmentally friendly way, that will continue to provide employment. Is it not time that the Scotland Office or the Department of Trade and Industry gave some encouragement to ensure that we are in that market, which should not go to Scandinavian countries alone?
Miss Begg: I did not intend to talk about decommissioning, because I want to be optimistic. Many fields that were set for decommissioning have not been decommissioned. Indeed, some small operators that have not yet extracted any oil out of the ground are currently looking to buy up licences that have already been classed as redundant. The oil industry has a long-term future. The hon. Gentleman is correct to say that there will be an issue about who gets the decommissioning work, which we must ensure is done in an environmentally friendly way.
It is important that businesses, operators and contractors in both Aberdeen and the rest of the north-east are part of the oil industry's future. We are already seeing much of the expertise that has been developed in the North sea being exported abroad. Many Aberdeen companies are already operating in a global market. That is the short-term future of the oil industry. However, if Aberdeen is to continue to sustain its economy, it must not only look beyond the oil industry, but consider how it can use its expertise in new energy technologies. There are new imperatives affecting the energy industry, such as environmental pressure, which the hon. Gentleman mentioned. Environmental pressures will ensure that we deliver energy in a sustainable way that does not ruin our environment, but it is also important that we have cheap energy. If the oil price continues to rise we may reach a stage where it becomes unsustainable as a fuel because it is both expensive and environmentally unacceptable.
Aberdeen needs to be ready. The Government need to be aware of Aberdeen's expertise, and Aberdeen's companies and businesses operating in the energy market need to prepare for developments. It is important that we start to address these issues now so that we do not miss the boat. There are two reasons why we must consider environmental imperatives. First, we need to make oil and gas cleaner fuels so that they will continue to be used in the future—something that we are beginning to see with the production of liquefied

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petroleum gas. I am very interested in liquid gas, which a company in my constituency, PCG, is developing with the government of Western Australia. Gas is turned into a liquid that can be used in diesel engines, which will be a cleaner fuel.
However, the aim is not only to make oil and gas cleaner fuels, but to develop renewable energies. Scotland is well placed to investigate the development of renewable energy sources. We have already led the world in the development of hydro-electricity, which has provided more than 10 per cent. of Scotland's energy needs over the past few decades, and our weather and geography lend themselves very well to the development of wave and wind power. I put in a plea on behalf of the technologies that are needed for offshore wind energy, many of which have already been used to develop the offshore oil industry.
I am not saying that Aberdeen should have offshore wind farms along its coast—it is not suitable, because much shallower water is required; nor that wave power is necessarily right on the east coast—it is more likely to be developed on the west coast or in the Moray firth. The role that I envisage for Aberdeen is that of a centre of excellence, knowledge and expertise. We have two universities—the university of Aberdeen and Robert Gordon university—which are already doing exciting development work on all aspects of energy. We have companies that are beginning to look to future development: major operators such as Shell, which is working on offshore wind, and BP, which is working on solar energy. I want that development to happen in Aberdeen, and to ensure that it is not exported abroad. I know that the Danes are far ahead of us in developing offshore wind energy. That is why my plea is for us to get involved now, so that as the oil industry moves onward and outward, and perhaps becomes less sustainable, the expertise in Aberdeen can be put to good use in other areas of energy production.
Mr. Russell Brown: Far be it from me to disagree with my hon. Friend and to say that Aberdeen should not be a centre of excellence. I fully support the whole principle of developing renewables; anyone who does not is surely somewhat foolhardy. However, does she not think that while the gas and oil industries have been developing over the past 20 or 30 years, we may have missed the boat in terms of research and development into renewables, and that we should have been concentrating more time and effort on that?
Miss Begg: I would love to be able to rewrite history. Perhaps my hon. Friend has a point and we should have been thinking about that sooner, but it is not too late—although it may be soon—provided that we get on the bus now. We should remember that during the industrial revolution Britain appeared to be way ahead of all the other European countries, but Germany introduced the newer technologies while Britain was using the older technologies, and stole a march on us. That may be the case with some renewables—certainly, research has gone down several blind alleys in developing wind and wave power.
Now is the right time to get into renewables and to ensure that the expertise that has been developed over the years in Aberdeen is used. Those brains should be
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used to look into solutions for renewables. For example, in the development of wind power, it is important to get windmills right in terms of gearing and size, and in using new material that makes them light but strong enough not to break in winds of varying strengths. That is a difficult relationship to get right, and there is work to be done on it. I do not want to suggest that there are just one two areas of possibility; things will be happening in Aberdeen and elsewhere that I have not heard about and cannot dream of, but which are none the less very important.
My message to the Government on the energy strategy is that the future of Aberdeen and the north-east could be bright. To the doom and gloom merchants who say that it will all end in tears and the oil will soon run out, my answer is no, it still has some time to go—and even when it does run out we will be well poised to create a sustainable economy through diversification into other energy sectors.
I want Aberdeen to change from the oil capital of Europe into the energy capital of Europe. With Government support, the help of the various operators and the expertise that we have in Aberdeen, I am sure that we can achieve that.
12.50 pm
The Minister of State, Scotland Office (Mr. George Foulkes): I sincerely congratulate my hon. Friend the Member for Aberdeen, South (Miss Begg) on securing a debate on a very important topic. I agree that it deserves more than half an hour, and I hope that we will find other opportunities to debate it.
I visited Aberdeen during the general election campaign, and I enjoyed my visit. I said then that my hon. Friend is one of the best constituency Members in the House of Commons. Fortunately, the electorate of Aberdeen, South recognised that, and she has demonstrated it again today. The way to represent one's constituents is to secure a debate and argue one's case forcefully, as my hon. Friend did, rather than tabling 250 questions for written answer. Such round robins, costing £30,000, are a waste of public money. One such question asked how many photographers the Scotland Office has spent money on, and the cost in real terms since 1995. That is the kind of rubbish that we get from the immature representatives of the Scottish National party. I wish that they would take a leaf out of the book of my hon. Friend the Member for Aberdeen, South, who is a really good representative of her constituents.
As my hon. Friend knows, the United Kingdom Government remain responsible for the entire area of reserved issues, of which energy is one. Although energy is reserved to this Parliament, we all recognise that it impinges on a number of devolved responsibilities, not least the energy sector's significance in relation to jobs, as my hon. Friend said. As we pointed out in our submission to the review, there are 100,000 oil-related jobs in Scotland, and three of Scotland's top 10 companies are electricity generators and suppliers. That shows the importance of the sector in Scotland. Although energy policy is reserved, environmental issues are devolved, as are the promotion of renewable energy, energy efficiency, consents for new power stations, overhead lines and gas pipelines. That is why we in the Scotland Office have been working very closely with our colleagues in the Scottish Executive—officials and Ministers—on the entire energy review.

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The energy review is an important part of the Government's energy strategy. Some journalists have said that we are conducting the review in secret. Nothing could be further from the truth. In fact, all the submissions and minutes of meetings held so far are published on the web. We cannot be more open than that. Everyone can read about exactly what we are doing and the way we are doing it. We have had more than 400 substantive submissions and a couple of hundred insubstantial ones, including one from the SNP that did not say anything new. I had better not go on, as I might be accused of being a "Nat-basher"—[Interruption.] Ah, it worked.
Mr. Michael Weir: Speaking as one of the alleged immature representatives, I ask the Minister to deal with the issue and explain the Government's thoughts, particularly on renewable energy, and the way forward. The hon. Member for Aberdeen, South gave a very good speech on the oil industry, which I am interested in as it affects my constituency too. However, we must look beyond that to renewables. What are the Government's proposals for renewable energy? Do they intend to go down the nuclear road, as has recently been suggested?
Mr. Foulkes: I am happy to reply to that—a reply that will cost absolutely nothing. I share the vision that my hon. Friend the Member for Aberdeen, South set out, in which we build on the oil and gas industry. Aberdeen is recognised as the oil capital of Europe. In the light of the expertise, technology and skills of those in and around Aberdeen, including Robert Gordon and Aberdeen universities, we can see the potential that my hon. Friend describes for Aberdeen to become the energy capital of Europe, including renewables.
My hon. Friend the Member for Dumfries (Mr. Brown) asked my hon. Friend the Member for Aberdeen, South whether we had missed the renewables bus. That was the case until just over four years ago, but we saw the bus and got on it quickly. Matters have moved dramatically since then.
Renewables are vital and the Scottish oil and gas industry has much to be proud of. Aberdeen and Scotland as a whole have concentrated on people's skills and made a major contribution to the British economy. That is why PILOT was set up—it was formerly the oil and gas industry taskforce—of which I am a member, as well as being a member of the energy review. The vision of that taskforce is the United Kingdom oil and gas industry and Government working in partnership to deliver quicker, smarter and sustainable energy solutions for the new century. A number of taskforces have been set up within PILOT to help to achieve that vision. One is the oil and gas industry fabrication support group, which has identified significant opportunities for new businesses through diversification, one being energy from renewable sources. The skills of the oil and gas industry are being used to move into renewables, particularly onshore wind. I have seen Scottish Power's wonderful new development at New Cumnock in my constituency. The
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factory at Campbeltown will build the wind generators to which my hon. Friend referred and provide much-needed jobs. The development includes onshore wind, offshore wind and tidal stream turbines. I made a fascinating visit to Islay and saw one of the pilot schemes for wave generation, which provides the opportunity for large-scale development. Scotland is reported to contain 23 per cent. of the wind energy of Europe and it feels like it from time to time, especially in Orkney and Shetland which I visited recently.
Mr. Carmichael: As the Member representing Orkney, may I invite the Minister to return to Stromness in the near future to see for himself the excellent work that is being done at the marine energy test centre, which has been established there as a result of Scottish Executive and Highlands and Islands Enterprise initiatives?
Mr. Foulkes: Of course, I shall take up that offer. I welcome the chance to visit Orkney and Shetland, which are my only overseas visits since I changed my job.
Scotland, with its large natural assets, is favourably placed to make faster progress on renewables. We are already seeing progress, the obvious example being AMEC Border Wind. AMEC is one of the first oil and gas contractors to diversify into wind energy in response to the Government's target on renewables. The renewables obligation has made a substantial difference to the development of renewables with £800 million going to the renewables industry through the renewables obligation. That is a substantial contribution.
Another example is Agip (UK), which provides backing for Wavegen, whose generator I saw in Islay. We are keen to encourage further development along those lines. However, we face a number of challenges in the energy review. I do not have time to go into them all today, but I would welcome an opportunity to discuss the matter in more detail. We must focus on the tensions between energy policy and environmental objectives, which is a classic dilemma.
The future role of nuclear energy must be discussed because 45 per cent. of electricity in Scotland comes from nuclear generation. The two nuclear power stations have a finite life and we must work out how they will be replaced. We must all face up to that, including the nationalists, or the lights will go out all over Scotland and the United Kingdom and our constituents would not thank us for that. We need to achieve security and diversity of energy supply. We need to look at the future of the oil and gas sector, and the ways in which we can encourage the opening up of a marginal field. We need to look at the significance of transport as an energy consumer, and the need to tackle fuel poverty. That is something that, in terms of our poverty eradication agenda, we must not forget.
That is the purpose of the energy review. A meeting will take place tomorrow, which I shall attend, and we aim to report by the end of the year. I hope that all hon. Members present will find another opportunity to debate this matter, which is vital to Scotland and to Britain.

Lauren Wright
1 pm
Mr. Bill O'Brien (in the Chair): I now call the right hon. Member for South-West Norfolk (Mrs. Shephard). May I say how sorry hon. Members are to see that her leg is in plaster. We hope that it is not too serious, and that she soon recovers her former health.
Mrs. Gillian Shephard: Thank you, Mr. O'Brien, for your kind good wishes. All I can say is that just walking along and breaking one's leg is no fun at all. [Interruption.] As the hon. Member for Norwich, North (Dr. Gibson) says, it would have been better with a gin and tonic.
I am grateful for the opportunity to raise the case of Lauren Wright in this Chamber. In more than 30 years of experience in health, education and social services I have known no more appalling case than hers. This tragic child was let down by all those who should have cared for her. Despite warnings from people in the community, Lauren died by slow degrees, in full view of the agencies responsible for her care. We deserve to be told why, and that is why I am calling for a full public inquiry into the circumstances surrounding her death. I am supported today by the hon. Members for Norwich, North and for North Norfolk (Norman Lamb). The Minister will therefore readily understand that this is an all-party approach. I am also supported by my hon. Friend the Member for Mid-Norfolk (Mr. Simpson), who would have been here but has something wrong with his mouth—we people from Norfolk have some unfortunate afflictions at the moment, one way and another—and by my hon. Friend the Member for North-West Norfolk (Mr. Bellingham).
I shall give a brief and rapid outline of the facts. Lauren Wright was born on 16 July 1993; she died from a blow to the abdomen, with extreme bruising all over her body, on 6 May 2000, two days before the date of the case conference finally organised by Norfolk social services to discuss her plight. From her birth, she was known to Hertfordshire social services, and she became known to Norfolk social services from 31 July 1997. Her name was removed from the Hertfordshire child protection register in August 1998, after a residence order was granted to her paternal grandmother in Norfolk. In January 1999, Lauren began school at the William Marshall primary school in Welney. During 1999, her care was transferred to her father, Craig Wright, who married Tracey Wright in the summer of that year. Lauren then moved to live with her father and stepmother, next door to her paternal grandmother. Tracey Wright was employed as a supervisory assistant at the William Marshall primary school from April 1999. Her responsibilities included supervision of children's play at lunchtime.
Towards the end of 1999 there were reports of bruising to Lauren. On 30 November 1999 she was seen by a consultant community paediatrician. Further anonymous allegations from the community of neglect and emotional abuse of Lauren by her stepmother were made during the early part of 2000. Claims from the family that Lauren was being bullied at school resulted in her teachers being asked by social workers to monitor the situation. She was seen by a general practitioner at
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Upwell on 14 March 2000, and on 15 March by a paediatrician at the King's Lynn hospital. Both observed numerous bruises of differing ages on her body. The GP suspected abuse, and the paediatrician put them down to bullying at school. Police following up the case were told that the medical evidence was inconclusive.
Hertfordshire social workers visited Lauren at home on 25 April, and the next day they alerted Norfolk social services to their concerns about Lauren's appearance and behaviour. Between 2 and 5 May, she was dealt a fatal blow to the stomach. She died on 6 May. Her stepmother and her father were convicted of her manslaughter and her wilful neglect at Norwich Crown court on 2 October 2001.
That bare recital of the facts, appalling as it is, conceals the real concerns about this case, which are that Lauren's treatment by her stepmother took place in public, observed by the local community and under the gaze of doctors, teachers and social workers. Trial evidence revealed that Tracey Wright was seen hitting the child and screaming abuse at her; that she fed her pepper sandwiches and put bugs from the garden in her food; that the taps in the house were turned off so tightly that the child could not get a drink of water; that she was made to carry the schoolbags of her step-siblings; that she was taunted and tormented by her stepmother in the local shop, and was made to stand for hours fully dressed in front of a hot stove. Her class teacher, in evidence at the trial, said that she saw marks on Lauren
"lots of times, often she was covered with lots of small bruises and with major bruises about once a month. These included black eyes, bruising on her face and scratches across her back."
At the time of her death at the age of six, Lauren weighed little more than two stone. In the words of her head teacher, her physical deterioration had been
"apparent for at least five months before she died."
There can be no doubt that in Tracey Wright, the stepmother convicted of manslaughter, the agencies were dealing with an exceptionally evil woman. Martin Wright, the acting chief superintendent, said:
"I think that any human being who can inflict this kind of treatment on a defenceless child must notch up very near the top of the scale of inhumanity"—
and that is a comment from a policeman.
Tracey Wright was clearly also incredibly plausible. She apparently had an IQ of 78, but nevertheless deceived doctors, teachers and social workers. As Mrs. Cooper of Easton, near Norwich, in a letter to me dated 2 October said:
"Little Lauren went from six stone to just over two, her hair was falling out, she was of a shabby appearance, she seemed sad, not to mention all the different horrific bruising she endured. However plausible and deceitful Tracey Wright was, you just don't keep accepting excuses when a child is constantly and clearly suffering like Lauren. This was going on for sixteen months, not just a one off occurrence, what more evidence did they need?"
After Lauren's death, Norfolk social services department asked the area child protection committee to review its procedures. That department is already the subject of a critical child care inspection report, carried out in 2000. Lauren's death is the fourth in as many years of a child under the protection of Norfolk social services. The ACPC report reveals some of the failures

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in Lauren's case, including failure to follow up action and no action at all being taken following reports from the public of abuse. As David Wright, the director of social services, in a letter to me of 29 August said:
"There were failings in other agencies but I believe that our Department should have been able to intervene to save her."
Mr. Wright has been candid about the shortcomings of his own department. We are not to know if any disciplinary action is to follow this appalling affair, but it is clear that there is a shortage of resources for Norfolk social services—although I shall not major on that point. Mr. Wright describes the position thus:
"Our thin blue line of child protection workers feels stretched close to transparency."
He points out the contrast between Norfolk funding which, on paper anyway, allocates to services for children under 18 something like £117 per head, while for Westminster the allocation is £577 per head—five times the amount that Norfolk is adjudged to need. That, although it is a point, is not the main point that I want to make.
The trial following the death of Lauren Wright convicted her stepmother and father of manslaughter and wilful neglect, but its purpose was not to examine the roles of the public services involved. Those public services are accountable not only to all of us but to the 750 other vulnerable children in Norfolk. That is why I seek a public inquiry into the series of muddles, blind eyes, missed chances, errors and sloppy professional practice revealed by Lauren's death.
The Minister, whom I am glad to see here, will want to explain how Department of Health officials could have rejected my call for an inquiry before it reached her desk. She may even care to dissociate herself from their chilling words. I quote from The Times of 2 October:
"It would not be appropriate to hold a public inquiry into all the child killings that happen each year."
My plea is supported by nigh on 1,000 readers of the Fenland Citizen, a local newspaper, who have taken the trouble to petition the paper to indicate their support, and by the 98 per cent. of the Norwich-based Evening News readers who, in a telephone poll, demanded a public inquiry. That has been the unanimous message from the countless letters, telephone calls and e-mails that I have received from members of the public. I am delighted to see that my hon. Friend the Member for North-West Norfolk, who supports me, is here, and there is strong cross-party support for a public inquiry.
The following questions are among those that must be answered. What was the role of Hertfordshire social services department in the affair? Did it make its Norfolk colleagues aware of its concerns for Lauren? Why did it visit Lauren in April 2000? If it had not, would Norfolk social services have remained unaware of Lauren's plight? Did the head and class teacher at the William Marshall school in Welney follow Norfolk's child protection procedures that were in force at the time of Lauren's death? Those procedures require teachers to report to the education welfare service, among other things that might indicate the abuse of a child:
"listlessness, poor physical growth, weight loss, looking very tired, bruising or lacerations."
I do not know whether the teachers did what their own authority required. Press reports indicate that they expressed their concerns only to Tracey Wright. Did
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they, or did they not, follow the local education authority's procedures? If they did not, what action will the LEA take, and did they really not do that because neither of the two teachers was a designated teacher? The school has only 30 pupils, for heaven's sake; there is the head and there is the teacher. One of the excuses for taking no action is that at the time there was no designated teacher concerned with non-accidental injury to children. That is the most extraordinary excuse that I have ever heard. What was the role of the head teacher? If there was not a designated teacher, was the head teacher able to say, "There isn't a designated teacher, so it's nothing to do with me." We do not know. How long was the school without a designated teacher, and what did the LEA do about that problem? When was Tracey Wright dismissed from her post at the school? On the day that she was found guilty of manslaughter? I suspect so.
What action was taken by the paediatrician who saw Lauren Wright on 30 November 1999, fully five months before she died? Was it his advice that "reassured" social services so that it took no action at that stage, which self-evidently was a time when Lauren could have been saved? On 14 and 15 March 2000, when Lauren was seen by a general practitioner and then a paediatrician, did they discuss their differing interpretations of the bruising on her body? What contact did the paediatrician have with the school to support his assertion that the bruising had been caused by bullying at school? Lauren could, even at that stage, have been saved. I put those questions to the Norfolk health authority. It replied that it was not
"able to supply information that is not currently in the public domain."
However, there have been developments. Last night, the chairman of the Norfolk health authority, Mr. John Alston, contacted me. He told me that the letter from the health authority to me, dated 12 October 2001, was neither factually correct—that was not the word that he used, but we are in Parliament now—nor complete. He said that the original version of the letter, which I have not seen, but which is being faxed to my home this morning, had been reduced and altered by the regional press officer to the version that I was given. What sort of operation is this? Obviously, I will pursue the matter—I am not majoring on that this morning either, because the Minister has not been warned and clearly cannot know the answer. However, she will hear from me, especially when I receive the original version of the letter. This does, however, support my demand for a public inquiry. How can we trust the health service if it cannot even give a Member of Parliament a factually correct and complete set of answers to a number of questions?
Norfolk social services has rightly shouldered much of the blame for the case, but its professionals are not the only ones involved, nor is it the only local authority concerned. People from all over the United Kingdom have contacted me to express their disgust at the circumstances of Lauren's death, with its revelations of failure of professional judgment and liaison. They, and we, are not prepared to be fobbed off with promises of internal NHS agency inquiries, in which the conduct of the doctors concerned will be examined by other doctors. Nor will we be fobbed off with attempts to bolt this case on to another appalling case, that of Victoria

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Climbie. We are sick and tired of hearing about procedures, strategies, reports and restructuring. In the name of the thousands of vulnerable children at risk across Britain, the Minister should today demonstrate her concern by announcing an immediate public inquiry into the case of tragic Lauren Wright.
1.16 pm
Dr. Ian Gibson: I congratulate the right hon. Member for South-West Norfolk (Mrs. Shephard) on securing this debate and on her tenacity in pursuing an appalling case. It is a special case in that it is the fifth in Norfolk in the past few years. The public in Norfolk have a crisis of confidence in social services and their delivery on such issues. That will have to be addressed by an open and transparent public inquiry. There is a lot to be said and there should be no attempt to hide what went on in this tragic case. Unless there is a public inquiry, confidence in Norfolk will erode. Such a case must never ever happen again—and if we do not get it right, there will be another such case.
I am not going to blame individuals. A failure in the development of services has been admitted to. If we are to achieve the change that we need in the way in which such situations are addressed, only an inquiry will bring out all the issues in an open and transparent way and ensure that the public acquire the confidence that is sadly lacking.
I would like the inquiry not to be secret. It is possible to have an inquiry whose chair decides to open only a specific aspect to the public. That would increase suspicion. The whole inquiry will have to be open, because the case has touched the people of Norfolk so deeply. The morale of those who work for social services must be at rock bottom, too. There is a resource requirement to be examined. The way in which we treat our children, viewing them as possessions about whom no one can ask questions, is a general problem in society, which such an inquiry would illustrate.
I give my full support to the right hon. Lady in her demand for a public inquiry. I hope that the Minister will listen and ensure that there is one. The case is a special one, against the background of a county struggling with such issues. Comparisons with anywhere else are not valid at this stage. Will the Minister ensure that the debate is opened up? We must see to it that this never happens again in Norfolk in our time.
Norman Lamb rose—
Mr. Bill O'Brien (in the Chair): I shall call the hon. Gentleman, but we do want to hear the Minister's answers to the questions that have been put. That is important.
1.18 pm
Norman Lamb: I understand that. I am grateful for the opportunity to contribute to the debate, and will keep my remarks brief.
The revelation that we have heard today concerning the apparent doctoring of a letter from the health authority is of enormous concern. It smacks to me of a spin too far, and of a cover-up, which strengthens the
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case for a full and proper public inquiry. For an information officer of a public body to conceal information is contrary to the whole public service ethos and ethic. I share the view of the right hon. Member for South-West Norfolk (Mrs. Shephard) that it is extraordinary that the officials in the Department of Health rejected calls for a public inquiry within hours of the verdict, without first hearing the case for one.
A public inquiry should consider two specific issues. It is important that we do not demonise social services or social workers. The thrust of an inquiry must be to avoid future tragedies. We must also examine the impact of staffing on the service, and the protection that it can provide with current staffing levels. We must confront that critical issue. We need to look at the co-ordination between agencies and different social services departments. I understand that issues of confidentiality and the requirements of data protection legislation may be preventing the necessary sharing of information. The use of information technology should give those who need to know access to information that can help inform judgment. An inquiry should consider whether data protection rules place impediments in the way of sharing information and investigating facts. For those reasons, I fully support the cause of the right hon. Lady and I urge the Government to avoid further delay in calling a public inquiry.
Mr. Bill O'Brien (in the Chair): I call the Minister.
Mr. Henry Bellingham rose—
Mr. Bill O'Brien (in the Chair): We must give the Minister a chance to respond.
Mr. Bellingham: I simply want to say that, as a neighbouring MP, I wholly support my right hon. Friend the Member for South-West Norfolk (Mrs Shephard).
1.21 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): Thank you, Mr. O'Brien. I am grateful to the right hon. Member for South-West Norfolk (Mrs. Shephard), and I acknowledge the widespread support from people in all parties for the points that she has made. The death of any child is desperately sad, but the death of a child through abuse or neglect is tragic. We know that at least one child each week dies as a result of abuse or neglect. That figure is horrifying. We must all share the responsibility of trying to protect children from abuse and neglect; it is a monumental task. Home Office research indicates that more than 100,000 adults in the UK have convictions for offences against children.
All agencies, and all people with child protection responsibilities, have to work together. As hon. Members have outlined, health, education, social services and other agencies make a complex jigsaw, the role of which is to ensure that concerns are picked up. We are all too aware of the tragedies that can unfold when vital information is not shared between different agencies.
Lauren's death should not have happened. Social services have made a public acknowledgement that had the procedures been followed, the matter would have

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been noticed, action would have been taken, and Lauren's death would have been avoided. However, I want to make it clear that Lauren was not killed by social workers or health workers. Lauren was killed by those who should have been caring for her—people who should have safeguarded, nurtured and cherished her. Mistakes were clearly made in the inter-agency handling of the case, but we must not place the responsibility for her death solely at the door of the statutory agencies.
There is always publicity when things go wrong in child protection cases because of the nature of the issues, but too often little is said about the excellent work carried out by social services and other agencies across the country to protect hundreds of thousands of children from harm. Some 160,000 children are referred to social services every year. Nearly 30,000 are added to the child protection register each year, and the vast majority of those children will have better lives because once they are registered the authorities can intervene and be effective. It would be very wrong to think that all children are being failed by our child protection system, but when things go wrong, we have a vital responsibility to find out why.
The "Working Together to Safeguard Children" guidance states that when factors of abuse or neglect are known or suspected to be a factor in a death, local agencies should get together to consider whether lessons can be learned from the terrible incident. When a child dies in such circumstances, the area child protection committee should always conduct a review, the purpose of which is to identify the lessons to be learned and to set out steps about how they will be acted upon, what is expected to change as a consequence, and how interagency operations can be improved. A serious case review of the circumstances leading up to Lauren's death has been undertaken. A summary of that review was published on 5 October, and there is an action plan to take forward all its recommendations.
Norfolk social services department is already under close regional monitoring as a result of a report into children's services in 2000. The Department of Health social services inspectorate will continue to monitor the implementation of that specific action plan by the social services department. The area child protection committee will take local responsibility for the implementation of those plans. There will be a follow-up inspection by the social services inspectorate, which is planned for January. It will assess the safety of all procedures in Norfolk and, crucially, how the recommendations are being implemented. A social services inspectorate and Audit Commission joint review are scheduled for March 2002, which will again closely monitor the situation.
I understand Members' desire for a public inquiry into Lauren's death. We must be satisfied that the lessons learned from the serious case review and the action plan are being learned in Norfolk. There are several specific matters that the action plan promotes in terms of training, assessment frameworks and an integrated electronic recording system. One big issue in the case concerned the series of notes written by GPs and other professionals involved. There was no way in which those notes could have been brought together. With consent, an electronic system can help to ensure that those notes are immediately available and that we have protocols about data sharing, which is an important issue.
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All primary care trusts have a named doctor and a nurse for child protection. We must ensure that they take their responsibilities seriously. I take the point made by the hon. Member for Norwich, North (Dr. Gibson) that we are all responsible in that regard. Simply designating somebody to take on that responsibility does not remove it from everybody else involved in the system.
The question has been raised of having a public inquiry into this particular incident. There is obviously an on-going public inquiry into the case of Victoria Climbie. It is important to explain why the decision was taken to have a public inquiry in that case, but not in that of Lauren Wright. It is the first statutory inquiry into the death of a child for more than 20 years; there is not a public inquiry into each incident. The major reason why there has been an inquiry into the Victoria Climbie case concerns the complexity of the system, which involved approximately nine different statutory agencies. We want to ensure that we learn the lessons from that inquiry, and how they can impact on incidents such as the one that we have discussed today. We shall ensure that the issues raised by the Climbie case are taken into account in Norfolk. We already have a wide-ranging inquiry in operation and we do not want to duplicate the issues that will arise from it.
Another key reason why a public inquiry will not take place in the case of Lauren Wright is that there will be an external independent review covering the health services aspects of the case, which concern the King's Lynn and Wisbech trust, the West Norfolk primary care trust and the Fenland primary care trust.
Mrs. Shephard: Will that review be conducted by doctors?
Ms Blears: It will be conducted by the Royal College of General Practitioners and the Royal College of Paediatricians. It will be external and independent, and people who have not been involved in the case will conduct it. It is expected that the review will cover competence and confidence, communication and transfer of information, and the policies and procedures within each trust. The action plan that has been produced provides a positive way forward for dealing with the specific issues concerning child protection in the Norfolk area. I take the point that there are other cases that underline Members' concerns about issues in that area.
The best way to safeguard children in Norfolk is to ensure that we implement the recommendations in the action plan. We must monitor that process and ensure that those steps are being taken. In future, there must be proper co-ordination across all agencies because, as has been said, if the procedures had been followed in this case, Lauren need not have died. Later, we can learn the lessons of the Victoria Climbie inquiry to try to make sure that we safeguard children wherever they may be. We are taking steps to ensure that we protect children in this community as far as we possibly can. The scale of the problem is immense, but we must ensure that the action plan is implemented in Norfolk, as well as elsewhere in the country. Lauren's death need not—and indeed, must not—have been in vain.

Consumer Credit
1.29 pm
Mr. Barry Gardiner: In securing this debate, my original intention was to examine the words of a young Back Bencher who, in 1987, was discussing that part of the consumer credit industry referred to as "sub-prime". He said:
"I think you need some measure of control and regulation to ensure that the unscrupulous aren't lending to the desperate when there's no possibility of repayment."
The young Back Bencher in question is now the Prime Minister.
I planned to examine today what effect the intervening years have had on the consumer credit industry. I wanted to look at current Government proposals, such as the task force on overindebtedness, and to discuss with the Minister ways in which consumer credit legislation could be updated. However, a particular aspect of the consumer credit industry has come to the fore during my investigations of the past 24 hours, and it is that aspect that I now want to raise with the Minister. She and I therefore share a common dilemma in that both of us may have to tear up our prepared speeches. I trust that she will be able to go with the flow of today's discussion.
On Friday 28 November 1997, before His Honour Judge Rubery at Stoke-on-Trent county court, the case of City Mortgage Corporation v. Riley was concluded. Given the Minister's previous role in the Government, she will be familiar with City Mortgage Corporation and many other financial corporations that I will talk about today. It must be said that CMC is not a company with a good track record in the industry. This was a typical case, like many that CMC had taken to court, involving repossession of a family's property. Of course, the mortgage had been secured on the property, but I am pleased to say that the judgment was not as CMC might have expected.
CMC argued that, although an equitable interest had been transferred to an American-based company called Greenwich International Ltd., CMC none the less had the right to enforce the debt. I am pleased to say that the court found otherwise. Mrs. Riley had done quite a bit of background work, and discovered documentary evidence showing that the legal interest, as well as the equitable interest, had been transferred to Greenwich International. The charge by CMC had never been registered because the Rileys' mortgaged property was not registered land. In accordance with section 114 of the Law of Property Act 1925, the deeds operate to transfer all rights to sue on the security to Greenwich International in America, rather than City Mortgage Corporation.
The long and the short of it is that, having pursued this debt, City Mortgage Corporation was found unable to do so by the courts because it had no legal standing, and costs were awarded against CMC. Before dealing with the significance of this case, I must tie it in with a second case that was heard at Basingstoke county court on 21 March last year, over which His Honour Judge Anthony Thompson QC was presiding. The case was that of Rozak v. Capital Credit Ltd. I know that the Minister will be familiar with the name of Capital Credit.
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Judge Thompson's summation outlined the following. The proceedings had been commenced in February 1998, at which stage it was a mortgage possession action brought by the then claimants, City Mortgage Corporation—hon. Members will see that a link is already beginning to develop—against Mr. and Mrs. Rozak in respect of their property. That claim was settled and the Rozaks lost their property. However, the case that Judge Thompson was dealing with was a claim by the Rozaks against Capital Credit Ltd.
The background is that Mr. and Mrs. Rozak lived at their home for about 20 years prior to its repossession. It was a council house that they were eventually able to purchase under the Government's right-to-buy scheme. They bought the property with the aid of a mortgage of £29,000 from the Nationwide building society. Problems set in for the Rozaks in 1992, when Mrs. Rozak lost her job as a result of industrial injury, and arrears began to accrue on the property. Judgments were made against them in the county court. I stress that at all stages the Nationwide building society acted absolutely properly in this case.
By 1997, the situation had become quite serious and the Rozaks were on the point of having legal action taken against them by the Nationwide. During a further visit from the building society, the seriousness of their financial position and the arrears that had fallen due were made clear to them.
In effect, the Rozaks needed to borrow £7,500, but they did not know where they were going to get it from. At that time they saw in the News of the World an offer of loans and finance placed by Capital Credit Ltd., which said that they had a chance to
"clear all your debts with cash to spare on low monthly payments".
Sums from £3,000 to £250,000 could be agreed. It was a tempting offer, which the Rozaks could not refuse, so they got in touch with Capital Credit. Capital Credit told them that because of their bad credit history it would not be able to give them the loan. However, it then offered them the opportunity to have someone come and talk to them about the possibility of a different loan, and sent a broker to meet them for that purpose.
At the meeting, the Rozaks were completely duped. They had wanted a loan of £7,500, but they were induced to remortgage entirely; instead of paying off their loan to the Nationwide, the new broker put them into an agreement with the City Mortgage Corporation. That loan was for a figure of some £47,000—a sum that at the increased rates of interest due on the mortgage, the Rozaks had no possible way of repaying.
What the Rozaks did not know was that the broker was a tied broker, and that they had entered into an agreement with City Mortgage Corporation with the original broker from Capital Credit. That agreement—I have a copy here, and will be happy to make it available to the Minister—was dated 21 December 1995 and was between City Mortgage Corporation Ltd., Capital Credit Ltd. and a certain Mr. Anthony Murtagh. It is a commission agreement. The court rightly looked at the agreement and the ruling by Judge Thompson explained that the broker was legally obliged to act on behalf of the Rozaks, but had not done so.

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It was clear from the right of first refusal in the agreement that Capital Credit acted as agents of the party whom they introduced—City Mortgage Corporation—rather than the Rozaks, and that although they owed that fiduciary duty to the Rozaks, they had in fact received secret commissions under the terms of the agreement. The court found that those commissions should be repaid, and that sum, plus costs, was made over to the Rozaks. However, to receive approximately £9,000 after losing the family home was a severe and bitter blow. It did not seem like compensation, because CMC had already obtained the Rozaks' home under a previous court judgment and sold it at a vast profit.
It is clear that secret commissions are a feature of the sub-prime lending market. Most mortgage lenders pay a fee to brokers for introducing a borrower; that is standard practice throughout the industry. The fee paid by a high-street lender for a standard domestic mortgage would probably be around £250. However, a non-status lender in the sub-prime market, which specialises in lending to people with poor credit ratings, often pays brokers a much higher introductory commission of up to 10 per cent. of the loan. That creates a clear conflict of interest between broker and client. If the broker persuades a prime lender to grant a £50,000 loan, the client receives an inexpensive loan, but the broker receives only around £250. If the broker places the client with a non-status lender or sub-prime lender, the broker may pocket up to £3,000, which is a common figure for brokers in the sub-prime market to expect as commission. In the Rozaks case there was not only £3,000 up-front commission, but additional secret commission which took the figure up to about £8,000. The rule of thumb is that the worse the mortgage, the higher the commission paid to the broker.
Some mortgage brokers place themselves in a particularly difficult position, as did Capital Credit, because they take commission from both sides. Capital Credit took the up-front commission of £3,000 but also received a finder's fee from the lender, or a first refusal commission, as the agreement to which I referred explains. Under civil law, a bribe is the payment of secret commission, which only means that, first, the person making the payment makes it to the agent of the other person with whom he is dealing; secondly, he makes it to that person knowing that that person is acting as the agent of the other person with whom he is dealing; thirdly, he fails to disclose to that other person with whom he is dealing that he has made the payment to the person whom he knows to be the other person's agent. If a lender gives money to a broker and does not tell the borrower that he is doing so, no matter what the intention, it is a bribe under the law. It is not necessary to establish a corrupt motive, nor does the principal have to show that the agent was influenced by the bribe.
The judge concluded by stating:
"there is no doubt that the defendants (Capital Credit) were tied brokers and had to offer, pursuant to the 'first refusal' agreement, all transactions primarily to CMC. It is also clear that there was a secret commission which was by the very nature of the first refusal agreement kept confidential and which was paid to the defendants by City Mortgage Corporation apparently on 1 May 1997 in respect of this transaction... At the end of the day what this comes to is this, here was a secret commission and on the basis of the authorities to which I have referred I am satisfied that in those
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circumstances Mr. and Mrs. Rozak are entitled either to recover damages or at their election to recover the commissions which were paid."
The Rozaks did that, but it was not adequate compensation for having been duped into remortgaging, for not being able to pay off their original small debt to Nationwide, and for subsequently finding that their home was repossessed.
I started my speech by referring to the other case, in which it became clear that parties who had no right to repossess a home were doing so. That is the situation with regard to much of the sub-prime market. The Land Registry should record a charge against a property, as under the Companies Act—section 395, which is about the first charge form—only where the parties seeking to record such an interest have proved that they are creditors with all the rights, responsibilities and duties pursuant under the definition of a creditor under the Consumer Credit Act 1974.
At the moment, it is possible for someone to register a charge against a property even though they are not the legal owner of the loan against that property. The original case that Judge Rubery ruled on sets that out clearly. Unfortunately, the Land Registry does not make that clear, so most people in the sub-prime market have a charge against their property recorded by someone who is not the legal owner of the loan.
The case of City Mortgage Corporation offers a very good example of how that has been done. The company collapsed in 1997 as a result of a class action brought against the parent company, which was called Cityscape. The action was brought by the shareholders as they had, in effect, been lied to about how United Kingdom loans had been securitised. An out-of-court settlement was agreed with those shareholders, which was worth many millions of dollars. After City Mortgage Corporation collapsed, a company called Ocwen US began to collect the UK loans. Borrowers thought that Ocwen US owned the loans, but it did not. Ocwen US then set up a company called Ocwen UK, which sought to buy out the loans from Cityscape. There was a falling out over that, and in 1998, when the Office of Fair Trading issued guidelines to stop dual interest rates, Ocwen UK announced a mortgage holiday. That marked one of the substantial successes of the Office of Fair Trading at that time.
Ocwen UK was bought by the Royal Bank of Scotland in 1998 and a new company called the "I" Group was set up. I am aware that these names are very familiar to the Minister—although of course I am not referring to the Royal Bank of Scotland. The "I" Group is another extremely disreputable lending company. The Royal Bank of Scotland's intention was to clean up the sub-prime market. In fact, the "I" Group did not adhere to the regulations attached to it by the Royal Bank of Scotland and Ocwen Loans was still being sold and marketed as such until the middle of 2000. The "I" Group has now been bought out by GE Capital. In June of this year, it paid approximately £200 million for £1.6 billion worth of loans.
The difficulty is not keeping tabs on such matters—which is difficult enough—but in drawing together the strands. I want to explain matters as briefly as possible so that the Minister can at least acknowledge the problems. I do not expect her to make a substantive response this morning, but I hope that she will

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undertake to explore them further. Claims like that by Mr. and Mrs. Rozak are outstanding against the "I" Group, which is owned by GE Capital, which bought it from the Royal Bank of Scotland, and they could be worth about £1.25 billion. Such claims are every bit as good as the Rozaks' claim, and would stand up in court against the group because of the way in which homes have been repossessed by companies that had no legal ownership of the loans outstanding and charged against those properties.
The Government should regulate to make it illegal for any broker to conclude a loan agreement without the inclusion of a standard sheet or form setting out clearly and precisely all remuneration that the broker receives by way of commission or in any other way from the lender or any other party in respect of the contract. The broker is, and should be, the agent of the borrower. The mortgage code lays that down, and it is followed by most of the major mortgage companies and lenders. However, the code is ritually ignored in the sub-prime market, so the borrower does not know of the secret commissions and bribes that are paid when he or she takes out a loan. They form part of the illegal commissions that companies such as CMC, Ocwen and the "I" Group have been receiving and have based their business on in the sub-prime sector for many years.
It is also important that the Government review the decision of the Office of Fair Trading to refrain from taking proceedings in the restrictive practices court in respect of the agreement between City Mortgage Corporation Ltd., Capital Credit Ltd. and Anthony Murtagh, to which I referred earlier. That agreement is no longer in force, but the OFT should initiate proceedings in respect of what happened. The Minister should convene a meeting with GE Capital about the claims that the "I" Group, which it owns, faces about the secret commissions on loan contracts that the group had concluded. The meeting should focus on the practice in the market of pursuing such loans through a party that, although registered at the Land Registry as having a first charge against the property, had no legal ownership of the loans in the first place.
1.54 pm
The Parliamentary Under-Secretary of State for Trade and Industry (Miss Melanie Johnson): My hon. Friend raises an interesting topic that concerns many consumers. He will forgive me if I concentrate largely on the general issues, because, as he will be aware, I have not received any prior details of some of the specific points that he made.
Many people use consumer credit because of the flexibility that it gives them in their financial planning, and to buy goods and services that they might otherwise be unable to afford. To make informed and confident decisions about credit, consumers need good quality information that allows them to make intelligent choices between different products and makes them aware of the risks to which they may be exposing themselves, especially in the case of loans secured on property. Those points are all relevant to the general thrust of my hon. Friend's argument.
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Consumers rely on consumer credit legislation to ensure that they receive the right information to provide them with the necessary protection. That is especially important for so-called non-status credit, when consumers face reduced choice because of problems that they have encountered with credit in the past, and may be at risk of exploitation.
The Consumer Credit Act covers credit of up to £25,000, so it would not cover some of the figures that my hon. Friend cited. It has been on the statute book since 1974, and the bulk of its associated regulations have been in place since the early 1980s. Its essential philosophy—that there should be truth in lending—remains as valid today as in 1974. Several amendments have been made to it since then, but there has been no major reform for almost 30 years. As I believe that there is room for improvement, I announced in July that the Department of Trade and Industry would undertake a wide review of the Act.
Several key factors led me to the conclusion that now is the time to review the Act. Credit products and marketing methods have changed a lot since 1974, and we need to ensure that the Act remains relevant and continues to offer consumers the protection that they need in the modern credit environment. In our election manifesto the Government undertook to increase protection against loan sharks. We need to examine whether existing protections against extortionate credit are effective, and whether provisions on consumer credit licensing can be improved so that the Office of Fair Trading can take vigorous enforcement action against rogue lenders and, when justified, exclude them from the market.
When I was Economic Secretary to the Treasury I decided that the Financial Services Authority should take responsibility for regulating mortgages, and the new regulatory regime is due to start next year. We need to ensure that regulation under the Consumer Credit Act complements the FSA regime.
Last year, the Government set up a task force on tackling overindeb edness. Its report, which I received earlier this year, contains several recommendations that I want to take forward. Some overlap with the subject matter of the Act, and it makes sense to take them forward at the same time as part of our review.
When I announced in July that we would be reviewing the Act, the DTI published a consultation paper entitled "Tackling loan sharks—and more", which set out the key objectives for the review—to develop a new consumer credit regime that targets rogue traders, reduces burdens on legitimate business, reflects market changes in consumer credit and improves the advice and information that consumers receive about consumer credit products.
Many of the changes that we want to make to our consumer credit legislation will have a particular impact on non-status credit. Our proposed changes affecting consumer credit licensing and extortionate credit will crack down on rogue lenders and help consumers who are parties to unfair deals. Our work on improving the transparency of loan information will also help

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consumers identify good deals and avoid those that are not such good value. The Director General of Fair Trading used his powers under the Consumer Credit Act 1974 to introduce guidelines to set out practices that he regards as deceitful, oppressive or otherwise unfair or improper, whether unlawful or not, and which would be likely to lead him to take regulatory action against licence holders or to consider his powers under the unfair terms and consumer contracts legislation.
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My hon. Friend has raised some interesting questions. The next course of action for him to take would be to set out his concerns in further detail in writing to me at the DTI, and if he does, I shall take up and consider the issues that he raises.
It being Two o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.